title: Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders.
abstract: OBJECTIVE
  This study identified patient-, hospital-, and community-level factors associated with timely follow-up care following psychiatric hospitalization for children and adolescents with mood disorders.
  
  
  METHODS
  The patients were 7,826 youths (ages six to 17) admitted to psychiatric hospitals with a primary diagnosis of mood disorder (July 2009-November 2010). Outcome variables were defined as one or more mental health visits within seven days and 30 days of psychiatric hospitalization. Predictor variables included patient-, hospital-, and community-level factors obtained from Medicaid claim files from four states (California, Florida, Maryland, and Ohio), the American Hospital Association annual survey, and the Area Resource File. Multilevel modeling was used to assess the association between patient-, hospital-, and community-level factors and receipt of follow-up care.
  
  
  RESULTS
  Following discharge, an outpatient mental health visit was obtained by 48.9% of children and adolescents within seven days and by 69.2% of children and adolescents within 30 days. Positive predictors of follow-up at both seven and 30 days included prior outpatient mental health care, foster care, psychiatric comorbidity, care in teaching hospitals and psychiatric hospitals, and residence in counties with more child and adolescent psychiatrists. Negative predictors included older age, black race, care in hospitals with higher levels of Medicaid penetration, and substance use disorders.
  
  
  CONCLUSIONS
  One in three youths did not receive mental health follow-up in the 30 days after psychiatric hospitalization. Linkage to follow-up care appears to be complex and multidetermined. Study findings underscored the need for quality improvement interventions targeting vulnerable populations and promoting successful transitions from inpatient to outpatient care.
authors.affiliation: Dr. Fontanella, Dr. Lester, and Dr. Campo are with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, and Ms. Hiance-Steelesmith is with the College of Social Work, Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Bridge is with the Department of Pediatrics, Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Ms. Sweeney and Dr. Hurst are with the Ohio Department of Mental Health and Addiction Services, Columbus.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Fontanella
authors.affiliation: Dr. Fontanella, Dr. Lester, and Dr. Campo are with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, and Ms. Hiance-Steelesmith is with the College of Social Work, Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Bridge is with the Department of Pediatrics, Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Ms. Sweeney and Dr. Hurst are with the Ohio Department of Mental Health and Addiction Services, Columbus.
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Hiance-Steelesmith
authors.affiliation: Dr. Fontanella, Dr. Lester, and Dr. Campo are with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, and Ms. Hiance-Steelesmith is with the College of Social Work, Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Bridge is with the Department of Pediatrics, Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Ms. Sweeney and Dr. Hurst are with the Ohio Department of Mental Health and Addiction Services, Columbus.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bridge
authors.affiliation: Dr. Fontanella, Dr. Lester, and Dr. Campo are with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, and Ms. Hiance-Steelesmith is with the College of Social Work, Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Bridge is with the Department of Pediatrics, Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Ms. Sweeney and Dr. Hurst are with the Ohio Department of Mental Health and Addiction Services, Columbus.
authors.forename: Natalie
authors.initials: N
authors.lastname: Lester
authors.affiliation: Dr. Fontanella, Dr. Lester, and Dr. Campo are with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, and Ms. Hiance-Steelesmith is with the College of Social Work, Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Bridge is with the Department of Pediatrics, Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Ms. Sweeney and Dr. Hurst are with the Ohio Department of Mental Health and Addiction Services, Columbus.
authors.forename: Helen Anne
authors.initials: HA
authors.lastname: Sweeney
authors.affiliation: Dr. Fontanella, Dr. Lester, and Dr. Campo are with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, and Ms. Hiance-Steelesmith is with the College of Social Work, Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Bridge is with the Department of Pediatrics, Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Ms. Sweeney and Dr. Hurst are with the Ohio Department of Mental Health and Addiction Services, Columbus.
authors.forename: Mark
authors.initials: M
authors.lastname: Hurst
authors.affiliation: Dr. Fontanella, Dr. Lester, and Dr. Campo are with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, and Ms. Hiance-Steelesmith is with the College of Social Work, Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Bridge is with the Department of Pediatrics, Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Ms. Sweeney and Dr. Hurst are with the Ohio Department of Mental Health and Addiction Services, Columbus.
authors.forename: John V
authors.initials: JV
authors.lastname: Campo
mesh_terms: D000293:Adolescent; D000359:Aftercare / Q000592:standards*; D000553:Ambulatory Care / Q000592:standards*; D002140:California; D002648:Child; D015897:Comorbidity; D005260:Female; D005431:Florida; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland; D008484:Medicaid; D019964:Mood Disorders / Q000453:epidemiology*; D015999:Multivariate Analysis; D009820:Ohio; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States