Predictors of timely follow-up care among medicaid-enrolled adults after psychiatric hospitalization.
OBJECTIVE
This study examined whether predictors of timely follow-up care after inpatient psychiatric discharge in non-Medicaid populations also predicted timely follow-up care among Medicaid-enrolled adults.


METHODS
The study examined the rates of seven- and 30-day follow-up care for 6,730 Medicaid-enrolled adults discharged from inpatient psychiatric facilities during 2004 and 2005 by using claims data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state. The relationship between predictor variables and timely aftercare was examined by using multiple logistic regression.


RESULTS
Thirty percent of individuals received follow-up care within seven days, and 49% received follow-up care within 30 days. After the analysis controlled for age and gender, those receiving clinical services in the 30 days before hospitalization were significantly more likely to receive follow-up care within seven days (odds ratio [OR]=3.59, 95% confidence interval [CI]=3.20-4.03) than individuals with longer inpatient stays (ten or more days) (OR=1.34, CI=1.15-1.57) and individuals from urban communities (OR=1.18, CI=1.05-1.34). African Americans (OR=.69, CI=.60-.78), individuals with co-occurring behavioral health and substance use disorders (OR=.78, CI=.68-.89), individuals involuntarily admitted (OR=.79, CI=.68-.91), and individuals discharged against medical advice (OR=.59, CI=.39-.87) were significantly less likely than their comparison groups to receive follow-up care within seven days. Thirty-day follow-up care results were similar.


CONCLUSIONS
Patient sociodemographic, clinical, and service utilization characteristics predicted timely follow-up care. Efforts to improve follow-up care utilization should target higher-risk individuals while developing and evaluating interventions to address specific barriers in these groups.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA. steinbd@upmc.edu
Bradley D
BD
Stein
Jane N
JN
Kogan
Mark J
MJ
Sorbero
Wesley
W
Thompson
Shari L
SL
Hutchinson
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000458:organization & administration*; D005260:Female; D005544:Forecasting; D006778:Hospitals, Psychiatric; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid; D008873:Mid-Atlantic Region; D008875:Middle Aged; D010351:Patient Discharge