Variation of Follow-Up Rate After Psychiatric Hospitalization of Medicare Beneficiaries by Hospital Characteristics and Social Determinants of Health

Benjenk, Ivy; Chen, Jie

doi:10.1016/j.jagp.2018.08.006

Cited by 23 publications

(17 citation statements)

References 32 publications

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“…These rates are similar to follow up-rates reported for Black (40.0%) and non-Hispanic White (50.9%) ED patients, and on par with the recently reported 30% seven-day follow-up rate in psychiatric patients after discharge from inpatient hospitalization. 31,32 This potential for difficult follow-up, coupled with the murky legal waters of consenting patients to enroll in a study while actively suicidal, were primary considerations in our decision to evaluate the feasibility of CALM-ED prior to attempting a randomized control trial into whether CALM leads to improved safe storage in suicidal patients.…”

Section: Limitationsmentioning

confidence: 99%

Counseling on Access to Lethal Means-Emergency Department (CALM-ED): A Quality Improvement Program for Firearm Injury Prevention

Mueller

Naganathan

Griffey

2020

WestJEM

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Introduction: Suicide is the 10 th leading cause of death in the United States, with firearms reported as the cause of death in up to 50% of these cases. Our goal was to evaluate the feasibility of the Counseling on Access to Lethal Means intervention in the Emergency Department (CALM-ED) by non-physician personnel. Methods: We conducted this single-center, prospective, quality improvement study (QI) in an urban, academic ED with over 90,000 annual patient visits. The study looked at adult patients who were discharged after presenting to the ED with suicidal crisis. Assessment of access to lethal means was conducted at the bedside, followed by a counseling session regarding safe storage of lethal means and follow-up via telephone call 48-72 hours after ED discharge. We collected data on patient's sociodemographics, psychiatric history, access to lethal means, lethal means storage methods, the patient's specific plans for lethal means storage after discharge, and post-discharge follow-up care. Results: Of 215 eligible patients, 166 voluntarily agreed to participate in CALMED , of whom 84 (51%) reported access to lethal means. Following the intervention, 75% of patients described a specific storage plan for their lethal means. Patients with and without access to firearms were equally likely to participate in the follow-up telephone call. Conclusion: An ED-based CALM QI intervention is feasible for implementation by non-physician personnel and is well received by patients and families. This intervention has the potential to help saves lives at times of suicide crisis. [West J Emerg Med. 2020;21(5)1123-1130.] is attempted. 4 While these findings suggest that many patients would benefit from outpatient mental healthcare, over 100 million people in the US live in a mental health-designated Health Professional Shortage Area, in which only 27% of the mental healthcare need is met. 5 Consequently, the emergency department (ED) is a frequent point of access to care for patients with mental health crises, with nearly 1% of all US ED visits in 2013 involved in evaluation and management of suicidal ideation (SI). 6 In

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Section: Limitationsmentioning

confidence: 99%

Counseling on Access to Lethal Means-Emergency Department (CALM-ED): A Quality Improvement Program for Firearm Injury Prevention

Mueller

Naganathan

Griffey

2020

WestJEM

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“…51 Furthermore, most of our patients were of low to average socioeconomic status, supporting the view that socioeconomic status may affect readmission rate. 7,13,54 In the present study, psychotic spectrum disorder was the most common diagnosis, followed by mood disorder. Morris et al 34 identified psychotic disorders in 26%, mood disorders in 36% and substance use disorders in 51% of patients readmitted to the emergency department within 30-day post-discharge.…”

Section: Discussionmentioning

confidence: 50%

Sociodemographic and clinical characteristics of patients with recurrent psychiatric readmissions in Qatar

et al. 2020

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Objective To examine the sociodemographic and clinical characteristics of psychiatric patients with recurrent psychiatric readmissions (RPR). Methods A retrospective study was conducted at Hamad General Hospital in Qatar on psychiatric patients with recurrent readmissions from August 2018 to January 2019. Results Of 380 psychiatric patients admitted during the study period, 40 (10.5%) were readmitted within 30 days of discharge. Most of the patients who were readmitted were single, male and unemployed. Psychotic spectrum disorder was the most frequent psychiatric condition and was diagnosed in 18 (45%) patients. A total of 30% of the patients were receiving treatment with anti-psychotics, and a similar number received more than one medication. Most patients showed poor or no compliance. Only 12.5% of patients stayed in the hospital for more than 5 weeks in their last admission during the study period. Conclusions Poor compliance, male sex and single status were the most common demographic and clinical features of patients with RPR. Post-discharge psychiatric care should be tailored to meet the requirements of patients prone to RPR.

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“…Providing follow-up after psychiatric hospitalization discharge has proven useful to reduce risk of non-adherence to medication and suicide [13,14]. Telepsychiatry may facilitate timely delivery of follow-up care after discharge and make it easier to support patients' adherence to treatment [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…However, only 55.8% of hospitals delivered timely care following psychiatric hospitalization, with psychiatric specialty hospitals, public hospitals, and minorityserving hospitals reporting lower follow-up rates within 30 days post discharge [16].…”

Section: Introductionmentioning

confidence: 99%

Telepsychiatry Adoption Across Hospitals in the United States: A Cross-Sectional Study

Harrison

et al. 2020

Preprint

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Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption.Methods Cross-sectional national data of 3,475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) reported having telepsychiatry. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%), with a wide variation across states. Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5% to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (-6.9% [-11.7% to -2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (-6.6% [-12.7% to -0.5%]) were less likely to have telepsychiatry. Conclusions Telepsychiatry adoption was low in US hospitals in 2017 with substantial variations by urban and rural status and by state. It raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

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Variation of Follow-Up Rate After Psychiatric Hospitalization of Medicare Beneficiaries by Hospital Characteristics and Social Determinants of Health

Cited by 23 publications

References 32 publications

Counseling on Access to Lethal Means-Emergency Department (CALM-ED): A Quality Improvement Program for Firearm Injury Prevention

Counseling on Access to Lethal Means-Emergency Department (CALM-ED): A Quality Improvement Program for Firearm Injury Prevention

Sociodemographic and clinical characteristics of patients with recurrent psychiatric readmissions in Qatar

Telepsychiatry Adoption Across Hospitals in the United States: A Cross-Sectional Study

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