title: Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?
abstract: OBJECTIVE
  Primary-care-based medical homes may facilitate care transitions for persons with multiple chronic conditions (MCC) including serious mental illness. The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity.
  
  
  METHODS
  Using a quasi-experimental design, we examined data from North Carolina Medicaid-enrolled adults with MCC hospitalized with an inpatient diagnosis of depression or schizophrenia during 2008-2010. We used inverse-probability-of-treatment weighting and assessed associations between medical home enrollment and outpatient follow-up within 7 and 30 days postdischarge.
  
  
  RESULTS
  Medical home enrollees (n=16,137) were substantially more likely than controls (n= 11,304) to receive follow-up care with any provider 30 days post discharge. Increasing patient complexity was associated with a greater probability of primary care follow-up. Medical complexity and medical home enrollment were not associated with follow-up with a mental health provider.
  
  
  CONCLUSIONS
  Hospitalized persons with MCC including serious mental illness enrolled in a medical home were more likely to receive timely outpatient follow-up with a primary care provider but not with a mental health specialist. These findings suggest that the medical home model may be more adept at linking patients to providers in primary care rather than to specialty mental health providers.
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. Electronic address: domino@unc.edu.
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Domino
authors.affiliation: Community Care of North Carolina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jackson
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; RTI International, Durham, NC.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Beadles
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Lichstein
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ellis
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morrissey
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; Community Care of North Carolina.
authors.forename: C Annette
authors.initials: CA
authors.lastname: DuBard
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000453:epidemiology / Q000628:therapy*; D009657:North Carolina / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*
keywords: Medical home; Multiple chronic conditions; Outpatient follow-up; Psychiatric hospitalization