Continuity of care after inpatient discharge of patients with schizophrenia in the Medicaid program: a retrospective longitudinal cohort analysis.
OBJECTIVE
This study seeks to identify patient, facility, county, and state policy factors associated with timely schizophrenia-related outpatient treatment following hospital discharge.


METHODS
A retrospective longitudinal cohort analysis was performed of 2003 national Medicaid claims data supplemented with the American Hospital Association facility survey, the Area Resource File, and a Substance Abuse and Mental Health Services Administration Medicaid policy report. The analysis focuses on treatment episodes of adults, aged 20 to 63 years, who received inpatient care for ICD-9-CM-diagnosed schizophrenia (59,567 total treatment episodes). Rate and adjusted odds ratio (AOR) of schizophrenia-related outpatient visits within 7 days and 30 days following hospital discharge are assessed.


RESULTS
Of the 59,567 hospital discharges, 41.7% received schizophrenia-related outpatient visits in 7 days and 59.3% in 30 days following hospital discharge. The adjusted odds of 30-day follow-up outpatient visits were significantly related to preadmission outpatient mental health visits (AOR = 3.72; 99% CI, 3.44-4.03), depot (AOR = 2.83; 99% CI, 2.53-3.18) or oral (AOR = 1.73; 99% CI, 1.62-1.84) antipsychotics as compared with no antipsychotics, and absence of a substance use disorder diagnosis (AOR = 1.35; 99% CI, 1.25-1.45). General hospital as compared with a psychiatric hospital treatment (AOR = 1.32; 99% CI, 1.14-1.54) and patient residence in a county with a larger number of psychiatrists per capita (AOR = 1.27; 99% CI, 1.08-1.50) were related to receiving follow-up outpatient visits. By contrast, residence in a county with a high poverty rate (AOR = 0.60; 99% CI, 0.54-0.67) and treatment in a state with prior authorization requirements for < 12 annual outpatient visits (AOR = 0.69; 99% CI, 0.63-0.75) reduced the odds of follow-up care.


CONCLUSIONS
Patient characteristics, clinical management, geographical resource availability, and the mental health policy environment all appear to shape access to care following hospital discharge in the community treatment of adult schizophrenia.
Olfson
Mark
M
Department of Psychiatry, Columbia University/ New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA. mo49@columbia.edu
Marcus
Steven C
SC
Doshi
Jalpa A
JA
D000284:Administration, Oral; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003692:Delayed-Action Preparations; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007273:Injections, Intramuscular; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D012565:Schizophrenic Psychology; D055502:Secondary Prevention; D014481:United States; D055815:Young Adult
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations