title: Reduced mortality among Department of Veterans Affairs patients with schizophrenia or bipolar disorder lost to follow-up and engaged in active outreach to return for care.
abstract: OBJECTIVE
  We determined whether contacting Department of Veterans Affairs (VA) patients with schizophrenia or bipolar disorders (serious mental illness [SMI]) who had dropped out of care for prolonged periods resulted in reengagement with VA services and decreased mortality.
  
  
  METHODS
  We developed a list of patients with SMI who were last treated in fiscal years 2005 to 2006, and were lost to follow-up care for at least 1 year. VA medical centers used our list to contact patients and schedule appointments. Additional VA administrative data on patient utilization and mortality through May 2009 were analyzed.
  
  
  RESULTS
  About 72% (2375 of 3306) of the patients who VA staff attempted to contact returned for VA care. The mortality rate of returning patients was significantly lower than that for patients not returning (0.5% vs 3.9%; adjusted odds ratio = 5.8; P < .001), after demographic and clinical factors were controlled.
  
  
  CONCLUSIONS
  The mortality rate for returning patients with SMI was almost 6 times less than for those who did not return for medical care. Proactive outreach might result in patients returning to care and should be implemented to reengage this vulnerable group.
authors.affiliation: Veterans Health Administration, Office of Medical Inspector, Washington, DC 20420, USA. cldavis@va.gov
authors.forename: Chester L
authors.initials: CL
authors.lastname: Davis
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.forename: John R
authors.initials: JR
authors.lastname: Pierce
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Winkel
authors.forename: Edward
authors.initials: E
authors.lastname: Huycke
authors.forename: Robert
authors.initials: R
authors.lastname: Langberg
authors.forename: David
authors.initials: D
authors.lastname: Lyle
authors.forename: Yancy
authors.initials: Y
authors.lastname: Phillips
authors.forename: Stephanie
authors.initials: S
authors.lastname: Visnic
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D012307:Risk Factors; D012559:Schizophrenia / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*