Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression.
OBJECTIVE
This study assessed whether increased frequency of clinical monitoring during the high-risk period of 12 weeks after discharge from a psychiatric hospitalization reduced subsequent rehospitalization in a national cohort of Veterans Health Administration patients receiving depression treatment between 1999 and 2004.


METHODS
A case-control design was used. Patients who had at least two inpatient psychiatric hospitalizations were identified (case group, N=17,852) and then individually matched with up to two patients who also had been discharged from psychiatric inpatient settings but were not rehospitalized for the number of days between the case-group patient's discharge and subsequent rehospitalization (N=35,511).


RESULTS
Covariate-adjusted relative risk (RR) did not show an association between increased monitoring and subsequent psychiatric hospitalization, but there was a significant negative interaction between monitoring and a comorbid substance use disorder diagnosis (p<.001). Increased monitoring was positively associated with rehospitalization of patients without a substance use disorder, whereas increased monitoring was not associated with increased risk of rehospitalization of those with a comorbid substance use disorder. The RR of rehospitalization associated with a weekly monitoring visit (12 visits per 84 days) versus no monitoring visit was 1.14 for patients without a substance use disorder, whereas the RR was reduced to .94 for patients with a substance use disorder.


CONCLUSIONS
Increased outpatient monitoring during the high-risk period after discharge appears to have a modest protective effect on rehospitalization among depressed patients with a comorbid substance use disorder.
Ann Arbor Center of Excellence, Serious Mental Illness Treatment Resource and Evaluation Center, U.S. Department of Veterans Affairs, Ann Arbor, Michigan, USA. myrakim@umich.edu
Hyungjin Myra
HM
Kim
Paul
P
Pfeiffer
Dara
D
Ganoczy
Marcia
M
Valenstein
D000328:Adult; D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000628:therapy; D006778:Hospitals, Psychiatric; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012306:Risk; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000628:therapy; D014728:Veterans / Q000523:psychology