title: Planning Patient-Centered Health Homes for Medicaid Psychiatric Patients at Greatest Risk for Intensive Service Use.
abstract: This study identified characteristics of Medicaid psychiatric patients at risk of hospitalizations and emergency department (ED) visits to identify their service delivery needs. A total of 4,866 psychiatrists were randomly selected from the AMA Physician Masterfile; 62 % responded, 32 % met eligibility criteria and reported on 1,625 Medicaid patients. Patients with schizophrenia, substance use disorders, suicidal and violent ideation/behavior, and psychotic, substance use, or manic symptoms were at high risk for intensive service use, along with homeless and incarcerated patients. Patients with schizophrenia or psychotic symptoms represented 37 % of patients, but used 73 % of all hospital days and 61 % of all ED visits. Patients with substance use problems comprised 21 % of patients, but used nearly half of all ED visits. Our findings highlight opportunities to enhance treatments and interventions, and inform the development of patient-centered health homes to address the needs of patients at high risk for intensive service use.
authors: American Psychiatric Foundation, 1000 Wilson Blvd, Suite 1825, Arlington, VA, 22209, USA, Jwest@psych.org.
authors: Joyce C
authors: JC
authors: West
authors: Donald S
authors: DS
authors: Rae
authors: Ramin
authors: R
authors: Mojtabai
authors: Farifteh F
authors: FF
authors: Duffy
authors: Janet
authors: J
authors: Kuramoto
authors: Eve
authors: E
authors: Moscicki
authors: William E
authors: WE
authors: Narrow
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006208:Halfway Houses; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D018802:Patient-Centered Care; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D011570:Psychiatry; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult