Local Health Departments’ Promotion of Mental Health Care and Reductions in 30-Day All-Cause Readmission Rates in Maryland

Chen, Jie; Novak, Priscilla; Barath, Deanna; Goldman, Howard H.; Mortensen, Karoline

doi:10.1097/mlr.0000000000000850

Cited by 18 publications

(19 citation statements)

References 37 publications

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“…Chen and colleagues (37) used a cross-sectional design to determine the association between mental health services provided by the local health department and the rate of readmissions in the locality. After controlling for the individual-level, hospital-level, and community-level characteristics, Chen found that hospitalized patients who reside in communities where the local health department provides direct preventative mental health services or non-preventative mental health services are significantly less likely to be readmitted within thirty days of discharge than hospitalized patients who reside in communities where the local health department does not provide those services.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the direct interventions that hospitals or outpatient providers can implement to reduce readmissions, the cross-sectional study by Chen (37) found that communities with strong public mental health infrastructure have lower thirty-day physical health condition readmission rates. A hospital’s ability to prevent readmissions is limited by the post-acute care infrastructure of the communities that they serve.…”

Section: Discussionmentioning

confidence: 99%

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Effective mental health interventions to reduce hospital readmission rates: a systematic review

Benjenk¹,

Chen²

2018

J Hosp Manag Health Policy

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Background: Hospitals in the United States are financially penalized for having a higher than expected thirty-day readmission ratio among patients initially hospitalized for heart failure, acute myocardial infarction (AMI), pneumonia, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG) surgery, or hip and knee replacement. Patients hospitalized for these conditions that have comorbid mental health diagnoses or symptoms are at high risk for readmission. Methods: We conducted a systematic review to determine if interventions, that are specifically designed to assess or treat mental health symptoms, can effectively reduce risk of readmission following hospitalization for physical health conditions. We searched on PubMed and Google Scholar for peer-reviewed articles published between January 2010 and June 2018 that examined the impact of mental-health interventions on readmissions for physical conditions. Results: After screening 81 full text articles, we found eleven intervention studies, one meta-analysis, and one cross-sectional study that met our inclusion criteria. Only three of the intervention studies found significant differences in readmission rates between intervention and comparison groups. Each of these interventions targeted patients after discharge from the hospital. One of the interventions was a physical health telemonitoring and individual psychotherapy intervention for patients that were initially admitted for heart failure. The second intervention was individual and group psychotherapy sessions for patients who were initially admitted for AMI. The third intervention was a nurse-driven depression care management protocol for home care patients with depressive symptoms who were initially admitted for any physical health condition. The cross-sectional study showed that communities with a stronger, social-based public mental health infrastructure had significantly lower physical health readmission rates. Conclusions: The literature identified in this review, appears to provide support for the use of mental health interventions after discharge as a mechanism for reducing physical health condition readmissions. Future research is needed to determine if these interventions can specifically reduce thirty-day readmissions for the six conditions linked to financial penalties.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Benjenk¹,

Chen²

2018

J Hosp Manag Health Policy

Self Cite

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“…It is well known that lack of treatment adherence is a key risk factor for hospitalization [ 94 ]. As well, the Quebec databanks did not include key variables, such as homelessness [ 95 ], race/ethnicity [ 32 , 96 ] or MD symptom severity, which may have contributed to hospitalization. Third, the interaction between factors not studied may have had an overall impact on study results.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions

et al. 2020

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Background This longitudinal study identified risk factors for frequency of hospitalization among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis. Methods Records of n = 11,367 patients were investigated using administrative databanks (2012–13/2014–15). Hospitalization rates in the 12 months after a first ED visit in 2014–15 were categorized as no hospitalizations (0 times), moderate hospitalizations (1–2 times), and frequent hospitalizations (3+ times). Based on the Andersen Behavioral Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014–15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalization rate. Results Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalizations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12–17 years) were risk factors for moderate hospitalizations, while higher numbers (4+) of overall interventions in local community health service centers were a risk factor for frequent hospitalizations only. Patients with personality disorders, drug-related disorders, suicidal behaviors, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalized. Less urgent and non-urgent illness acuity prevented moderate hospitalizations only. Conclusions Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalizations as compared with non-hospitalized patients. Patients at risk for frequent hospitalizations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalization.

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“…To provide additional context to understanding STAR implementation, important process measures are tracked in both groups, including: functional assessment or physical therapy consult [49, 50]; mental health assessment by PHQ-2 or PHQ-9 [51]; referrals to physical therapy or outpatient rehabilitation, speech therapy, and behavioral health [52–55]; early outpatient follow-up (i.e., completed outpatient primary care follow-up (or attendance at an AH Transition Services clinic) within 7 days of discharge) [56–60]; and documented medication reconciliation in the EHR during the 30 days post discharge [61, 62]. Because sepsis may occur in the setting of long-standing illness and declining health [63–65], we also measure the quality of end-of-life care, including place of death (i.e., hospital or other location) and the proportion of patients who received a palliative care consult, completed care preferences documentation, and were discharged to a hospice.…”

Section: Methodsmentioning

confidence: 99%

Structured, proactive care coordination versus usual care for Improving Morbidity during Post-Acute Care Transitions for Sepsis (IMPACTS): a pragmatic, randomized controlled trial

Kowalkowski

Chou

McWilliams

et al. 2019

Trials

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AbstractsBackgroundHospital mortality for patients with sepsis has recently declined, but sepsis survivors still suffer from significant long-term mortality and morbidity. There are limited data that support effective strategies to address post-discharge management of patients hospitalized with sepsis.MethodsThe Improving Morbidity during Post-Acute Care Transitions for Sepsis (IMPACTS) study is a pragmatic, randomized controlled trial at three hospitals within a single healthcare delivery system comparing clinical outcomes between sepsis survivors who receive usual care versus care delivered through the Sepsis Transition and Recovery (STAR) program. The STAR program includes a centrally located nurse navigator using telephone counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies for patients during hospitalization and the 30 days after hospital discharge, including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted through the Emergency Department with suspected infection (i.e., antibiotics initiated, bacterial cultures drawn) and deemed, by previously developed risk-stratification models, high risk for readmission or death are included. Eligible patients are randomly allocated 1:1 to either Arm 1, usual care or Arm 2, STAR. Planned enrollment is 708 patients during a 6-month period. The primary outcome is the composite of all-cause hospital readmissions and mortality assessed 30 days post discharge. Secondary outcomes include 30- and 90-day hospital readmissions, mortality, emergency department visits, acute care-free days alive, and acute care and total costs.DiscussionThis pragmatic evaluation provides the most comprehensive assessment to date of a strategy to improve delivery of recommended post-sepsis care.Trial registrationClinicalTrials.gov, NCT03865602. Registered retrospectively on 6 March 2019.

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Local Health Departments’ Promotion of Mental Health Care and Reductions in 30-Day All-Cause Readmission Rates in Maryland

Cited by 18 publications

References 37 publications

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions

Structured, proactive care coordination versus usual care for Improving Morbidity during Post-Acute Care Transitions for Sepsis (IMPACTS): a pragmatic, randomized controlled trial

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