Identifying Characteristics Associated With Timely Follow-Up Psychiatric Care

More than diagnoses and demographics influence whether youths receive critical outpatient care following psychiatric hospitalization. Individual attributes and aspects of the hospital where they receive treatment as well as the community they live in play roles, researchers from The Ohio State University and Nationwide Children’s Hospital have found.

Outpatient care is essential to patients’ success, due to short hospital stays, says Cynthia Fontanella, PhD, assistant professor of psychiatry at Ohio State, who led the study. “In the 1990s, patients would be admitted and stay for months, but now it’s three to five days. And that’s not long enough to stabilize kids.”

The highest risk period for relapse, readmission and suicide is the month following discharge. Yet nearly one in three youths fail to receive follow-up care in that time, the study shows.

“It’s important to identify factors associated with timely follow-up in order to target the most vulnerable youth,” says Jeffrey Bridge, PhD, director of the Center for Suicide Prevention and Research at Nationwide Children’s, and a study co-author. “We need to improve the transition from inpatient to outpatient care.”

Hospitals and outpatient providers need to do more to coordinate care and tailor treatment strategies to individual patients, based on a variety of influences, the authors say.

The researchers reviewed Medicaid records of 7,826 youths ages 6 to 17, admitted to psychiatric hospitals with a primary diagnosis of mood disorders. Half failed to receive outpatient care within a week of discharge and 31 percent failed within 30 days.

The strongest predictor for receiving timely follow-up care is having had an outpatient visit prior to hospitalization.

“It’s likely that having a relationship with an outpatient provider prior to discharge drives this finding,” Dr. Fontanella says. “It suggests we need more bridging strategies connecting patients with outpatient providers while they’re still receiving inpatient care.”

Children in foster care, those who have a psychiatric comorbidity, youths who received their care in a teaching or psychiatric hospital and patients who live in counties with more child and adolescent psychiatrists are all more likely to receive outpatient care within 30 days.

The strongest predictor against timely follow-up treatment is substance abuse. Other negative predictors are older age and race — African Americans were least likely to receive outpatient care compared with other racial or ethnic groups.

Treatment in a hospital with higher concentrations of Medicaid patients was tied to longer waits, possibly due to the lack of outpatient providers in the system.

Reference:

Fontanella CA, Hiance-Steelesmith DL, Bridge JA, Lester N, Sweeney HA, Hurst M, Campo JV. Factors associated with timely follow-up care after psychiatric hospitalization for youths with mood disorders. Psychiatric Services. 2016 Mar 1;67(3):324-331.