title: Reinstitutionalization following psychiatric discharge among VA patients with serious mental illness: a national longitudinal study.
abstract: Patterns of reinstitutionalization following psychiatric hospitalization for individuals with serious mental illnesses (SMI) vary by medical and psychiatric health care settings. This report presents rates of reinstitutionalization across care settings for 35,527 patients following psychiatric discharge in the Department of Veterans Affairs (VA) health system, a national health care system. Over a 7-year follow-up period, 30,417 patients (86%) were reinstitutionalized. Among these patients, 73% were initially reinstitutionalized to inpatient psychiatric settings. Homelessness, medical morbidity, and substance use were associated with increased risks for reinstitutionalization. Despite the VA's increased emphasis on outpatient services delivery, the vast majority of patients experienced reinstitutionalization in the follow-up period. Study findings may inform efforts to refine psychiatric and medical assessment for service delivery for this vulnerable population.
authors.affiliation: Department of Psychiatry, Mental Health Services, Outcomes, and Translation Section, University of Michigan, 4250 Plymouth Road, Box 5765, Ann Arbor, MI 48109, USA. cheryli@med.umich.edu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Irmiter
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Barry
authors.forename: Soheil
authors.initials: S
authors.lastname: Soliman
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006760:Hospitalization; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D009017:Morbidity; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*