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Quality of Follow-Up After Hospitalization for Mental Illness Among Patients From Racial-Ethnic Minority Groups
Nicholas J. Carson, M.D., F.R.C.P.C.; Andrew Vesper, Ph.D.; Chih-nan Chen, Ph.D.; Benjamin Lê Cook, Ph.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300139
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Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ncarson@charesearch.org). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States.

Methods  The Medical Expenditure Panel Survey (2004–2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference.

Results  Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge.

Conclusions  Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.

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Table 1Characteristics of white, black, and Latino patients with an inpatient admission for psychiatric treatment, in weighted, unadjusted percentages
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a For comparisons with white patients

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b Possible scores range from 0 to 24, with higher scores indicating greater psychological distress.

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c Possible scores on the Patient Health Questionnaire–2 range from 0 to 6, with a score above 3 indicating probable depressive disorder.

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d From the 12-Item Short Form of the Medical Outcomes Study. Possible scores range from 0 to 100, with higher scores indicating higher levels of mental health or physical health relative to individuals of similar age.

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Table 2Predictors of follow-up within seven and 30 days after discharge from hospitalization for mental illness
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a Any outpatient visit

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b Adequate treatment was defined as a treatment episode consisting of at least eight visits to a mental health provider or at least four mental health care visits or events and at least one psychotropic medication fill.

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Table 3Predicted probabilities of follow-up after discharge from hospitalization for mental illness before and after adjustment for prior office-based mental health treatment, by racial-ethnic groupa
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a Both analyses adjusted for clinical need variables.

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b Adequate treatment was defined as a treatment episode consisting of at least eight visits to a mental health provider or at least four mental health care visits or events and at least one psychotropic medication fill.

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