title: Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups.
abstract: OBJECTIVE
  Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States.
  
  
  METHODS
  The Medical Expenditure Panel Survey (2004-2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference.
  
  
  RESULTS
  Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge.
  
  
  CONCLUSIONS
  Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.
authors.affiliation: Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ncarson@charesearch.org). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Carson
authors.affiliation: Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ncarson@charesearch.org). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vesper
authors.affiliation: Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ncarson@charesearch.org). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan.
authors.forename: Chih-Nan
authors.initials: CN
authors.lastname: Chen
authors.affiliation: Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ncarson@charesearch.org). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lê Cook
mesh_terms: D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008913:Minority Groups / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States; D001741:Black or African American