title: First outpatient follow-up after psychiatric hospitalization: does one size fit all?
abstract: OBJECTIVE
  Claims-based indicators of follow-up within seven and 30 days after psychiatric discharge have face validity as quality measures: early follow-up may improve disease management and guide appropriate service use. Yet these indicators are rarely examined empirically. This study assessed their association with subsequent health care utilization for adults with comorbid conditions.
  
  
  METHODS
  Postdischarge follow-up and subsequent utilization were examined among adults enrolled in North Carolina Medicaid who were discharged with claims-based diagnoses of depression or schizophrenia and not readmitted within 30 days. A total of 24,934 discharges (18,341 individuals) in fiscal years 2008-2010 were analyzed. Follow-up was categorized as occurring within 0-7 days, 8-30 days, or none in 30 days. Outcomes in the subsequent six months included psychotropic medication claims, adherence (proportion of days covered), number of hospital admissions, emergency department visits, and outpatient visits.
  
  
  RESULTS
  Follow-up within seven days was associated with greater medication adherence and outpatient utilization, compared with no follow-up in 30 days. This was observed for both follow-up with a mental health provider and with any provider. Adults receiving mental health follow-up within seven days had equivalent, or lower, subsequent inpatient and emergency department utilization as those without follow-up within 30 days. However, adults receiving follow-up with any provider within seven days were more likely than those with no follow-up to have an inpatient admission or emergency department visit in the subsequent six months. Few differences in subsequent utilization were observed between mental health follow-up within seven days versus eight to 30 days.
  
  
  CONCLUSIONS
  For patients not readmitted within 30 days, follow-up within 30 days appeared to be beneficial on the basis of subsequent service utilization.
authors.affiliation: Dr. Beadles is with RTI International, Durham, North Carolina. He is also with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill (e-mail: beadles@email.unc.edu ), where Dr. Morrissey and Dr. Domino are affiliated. Dr. Morrissey and Dr. Domino are also with the Cecil G. Sheps Center for Health Services Research, UNC Chapel Hill, where Dr. Ellis is affiliated. Dr. Lichstein is with the Office of Planning, Analysis, and Evaluation, Health Resources and Services Administration, Rockville, Maryland. Dr. Farley is with the Eshelman School of Pharmacy, UNC Chapel Hill. Dr. Jackson is with the Department of Psychiatry, UNC Chapel Hill, and with Community Care of North Carolina, Raleigh.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Beadles
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ellis
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Lichstein
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
authors.forename: Carlos T
authors.initials: CT
authors.lastname: Jackson
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morrissey
authors.forename: Marisa Elena
authors.initials: ME
authors.lastname: Domino
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009657:North Carolina; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010045:Outpatients / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012559:Schizophrenia / Q000628:therapy*; D013997:Time Factors; D014481:United States; D016903:Drug Monitoring