Predictors of Timely Follow-Up Care Among Medicaid-Enrolled Adults After Psychiatric Hospitalization

Published in: Psychiatric Services, v. 58, No. 12, Dec. 2007, p. 1563-1569

Posted on RAND.org on December 31, 2006

by Bradley D. Stein, Jane N. Kogan, Mark J. Sorbero, Wesley K. Thompson, Shari L. Hutchinson

Read More

Access further information on this document at ps.psychiatryonline.org

This article was published outside of RAND. The full text of the article can be found at the link above.

OBJECTIVE: This study examined whether predictors of timely follow-up care after inpatient psychiatric discharge in non-Medicaid populations also predicted timely follow-up care among Medicaid-enrolled adults. METHODS: The study examined the rates of seven- and 30-day follow-up care for 6,730 Medicaid-enrolled adults discharged from inpatient psychiatric facilities during 2004 and 2005 by using claims data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state. The relationship between predictor variables and timely aftercare was examined by using multiple logistic regression. RESULTS: Thirty percent of individuals received follow-up care within seven days, and 49% received follow-up care within 30 days. After the analysis controlled for age and gender, those receiving clinical services in the 30 days before hospitalization were significantly more likely to receive follow-up care within seven days (odds ratio [OR]=3.59, 95% confidence interval [CI]=3.20-4.03) than individuals with longer inpatient stays (ten or more days) (OR=1.34, CI=1.15-1.57) and individuals from urban communities (OR=1.18, CI=1.05-1.34). African Americans (OR=.69, CI=.60-.78), individuals with co-occurring behavioral health and substance use disorders (OR=.78, CI=.68-.89), individuals involuntarily admitted (OR=.79, CI=.68-.91), and individuals discharged against medical advice (OR=.59, CI=.39-.87) were significantly less likely than their comparison groups to receive follow-up care within seven days. Thirty-day follow-up care results were similar. CONCLUSIONS: Patient sociodemographic, clinical, and service utilization characteristics predicted timely follow-up care. Efforts to improve follow-up care utilization should target higher-risk individuals while developing and evaluating interventions to address specific barriers in these groups.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.