Outpatient Follow-Up Care and Risk of Hospital Readmission in Schizophrenia and Bipolar Disorder
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Data Sources
Sample Selection
Independent Variables
Other Covariates
Dependent Variables
Statistical Analysis
Results
Outpatient Mental Health Follow-Up Visits: Patient Characteristics
Schizophrenia | Bipolar disorder | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
30-day follow-up visit (N=16,244) | No 30-day follow-up visit (N=9,157) | 30-day follow-up visit (N=32,329) | No 30-day follow-up visit (N=14,046) | |||||||
Characteristic | N | % | N | % | pb | N | % | N | % | pb |
Gender | <.001 | <.001 | ||||||||
Female | 7,270 | 44.8 | 3,683 | 40.2 | 20,736 | 64.1 | 8,178 | 58.2 | ||
Male | 8,974 | 55.2 | 5,474 | 59.8 | 11,593 | 35.9 | 5,868 | 41.8 | ||
Age | .157 | <.001 | ||||||||
18–24 | 3,036 | 18.7 | 1,620 | 17.7 | 7,167 | 22.2 | 3,654 | 26.0 | ||
25–35 | 4,058 | 25.0 | 2,372 | 25.9 | 7,205 | 22.3 | 3,297 | 23.5 | ||
36–45 | 3,168 | 19.5 | 1,798 | 19.6 | 7,057 | 21.8 | 2,879 | 20.5 | ||
46–64 | 5,982 | 36.8 | 336 | 36.8 | 10,900 | 33.7 | 4,219 | 30.0 | ||
Payment source | .072 | <.001 | ||||||||
Commercial insurance | 5,988 | 36.9 | 3,272 | 35.7 | 23,919 | 74.0 | 8,947 | 63.7 | ||
Medicaid | 10,256 | 63.1 | 5,885 | 64.3 | 8,410 | 26.0 | 5,099 | 36.3 | ||
Length of index admission (days) | <.001 | <.001 | ||||||||
Short (1–8) | 9,502 | 58.5 | 5,591 | 61.1 | 23,137 | 71.6 | 10,535 | 75.0 | ||
Medium (9–12) | 3,365 | 20.7 | 1,887 | 20.6 | 5,636 | 17.4 | 2,139 | 15.2 | ||
Long (13–30) | 3,377 | 20.8 | 1,679 | 18.3 | 3,556 | 11.0 | 1,372 | 9.8 | ||
Subtype | ||||||||||
Schizophrenia | <.001 | |||||||||
Schizoaffective | 8,090 | 49.8 | 4,045 | 44.2 | ||||||
Other | 8,154 | 50.2 | 5,112 | 55.8 | ||||||
Bipolar disorder | <.001 | |||||||||
Depressed | 14,565 | 45.1 | 6,223 | 44.3 | ||||||
Manic | 7,672 | 23.7 | 3,293 | 23.4 | ||||||
Mixed | 8,726 | 27.0 | 3,786 | 27.0 | ||||||
Other | 1,366 | 4.2 | 744 | 5.3 | ||||||
Substance use disorder in past 120 days | 4,265 | 26.3 | 2,686 | 29.3 | <.001 | 8,377 | 25.9 | 4,556 | 32.4 | <.001 |
Use of mental health services in past 120 days | ||||||||||
Inpatient | 1,192 | 7.3 | 629 | 6.9 | .164 | 3,084 | 9.5 | 1,215 | 8.7 | .002 |
Emergency department | 4,459 | 27.5 | 2,417 | 26.4 | .068 | 7,336 | 22.7 | 2,985 | 21.3 | <.001 |
Mental health professional | 14,023 | 86.3 | 5,557 | 60.7 | <.001 | 26,664 | 82.5 | 8,454 | 60.2 | <.001 |
No use of mental health services in past 120 daysc | 1,094 | 6.7 | 1,812 | 19.8 | <.001 | 2,240 | 6.9 | 2,269 | 16.2 | <.001 |
Rates of Mental Health Follow-Up Outpatient Visits
Schizophrenia | Bipolar disorder | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Variable | N | % | pb | AOR | 95% CI | N | % | pb | AOR | 95% CI |
Total | 16,244 | 64.0 | 32,329 | 69.7 | ||||||
Sex | <.001 | <.001 | ||||||||
Female (reference) | 7,270 | 66.4 | 1.00 | 20,736 | 71.7 | 1.00 | ||||
Male | 8,974 | 62.1 | .90 | .85–.96 | 11,593 | 66.4 | .87 | .93–.90 | ||
Age | .157 | <.001 | ||||||||
18–24 (reference) | 3,036 | 65.2 | 1.00 | 7,176 | 66.2 | 1.00 | ||||
25–35 | 4,058 | 63.1 | .87 | .80–.95 | 7,205 | 68.6 | 1.12 | 1.06–1.19 | ||
36–45 | 3,168 | 63.8 | .85 | .77–.93 | 7,057 | 71.0 | 1.17 | 1.10–1.24 | ||
46–64 | 5,982 | 64.0 | .81 | .74–.88 | 10,900 | 72.1 | 1.17 | 1.10–1.24 | ||
Payment source | .072 | <.001 | ||||||||
Commercial insurance (reference) | 5,988 | 64.7 | 1.00 | 23,919 | 72.8 | 1.00 | ||||
Medicaid | 10,256 | 63.5 | .85 | .80–.90 | 8,410 | 62.3 | .58 | .56–.61 | ||
Length of index admission (days) | <.001 | <.001 | ||||||||
Short (1–8) (reference) | 9,502 | 63.0 | 1.00 | 23,137 | 68.7 | 1.00 | ||||
Medium (9–12) | 3,365 | 64.1 | 1.10 | 1.02–1.18 | 5,636 | 72.5 | 1.21 | 1.14–1.28 | ||
Long (13–30) | 3,377 | 66.8 | 1.22 | 1.13–1.31 | 3,556 | 72.2 | 1.15 | 1.07–1.23 | ||
Subtype schizophrenia | <.001 | |||||||||
Schizoaffective | 8,090 | 66.7 | .91 | .86–.96 | ||||||
Other (reference) | 8,154 | 61.5 | 1.00 | |||||||
Subtype bipolar disorder | <.002 | |||||||||
Depressed (reference) | 14,565 | 70.1 | 1.00 | |||||||
Manic | 7,672 | 70.0 | 1.07 | 1.02–1.14 | ||||||
Mixed | 8,726 | 69.7 | 1.01 | .96–1.06 | ||||||
Other | 1,366 | 64.7 | .86 | .77–.94 | ||||||
Substance use disorder in past 120 days (reference: no) | 4,265 | 61.4 | <.001 | .69 | .65–.74 | 23,952 | 64.8 | <.001 | .66 | .63–.69 |
Mental health services in past 120 days (reference: no) | ||||||||||
Inpatient | 1,192 | 65.5 | .164 | .78 | .70–.87 | 3,084 | 71.7 | .002 | .92 | .86–1.00 |
Emergency department | 4,459 | 64.8 | .069 | .90 | .84–.96 | 7,336 | 71.1 | <.001 | .98 | .92–1.03 |
Mental health professional | 14,023 | 71.6 | <.001 | 3.32 | 3.04–3.62 | 26,664 | 75.9 | <.001 | 2.68 | 2.53–2.85 |
No use of mental health services in past 120 daysc | 1,094 | 37.6 | <.001 | 2,240 | 49.7 | <.001 |
30-day follow-up visit | Readmission within 31–120 days | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes | No | 30-day follow-up visit | No 30-day follow-up visit | |||||||||
Group | N | % | N | % | AORb | 95% CI | N | % | N | % | AORc | 95% CI |
Schizophrenia | ||||||||||||
White | 5,022 | 68.4 | 2,323 | 31.6 | 1.28 | 1.19–1.39 | 669 | 14.2 | 263 | 12.9 | .99 | .84–1.17 |
Black | 4,235 | 59.3 | 2,902 | 40.7 | 1.00 | 501 | 12.6 | 320 | 12.4 | .92 | .78–1.08 | |
Hispanic | 151 | 67.1 | 74 | 32.9 | 1.20 | .89–1.62 | 28 | 19.3 | 11 | 16.4 | 1.40 | .54–3.61 |
Other | 848 | 59.1 | 586 | 40.9 | .93 | .82–1.05 | 108 | 13.9 | 74 | 15.1 | .87 | .61–1.24 |
Bipolar | ||||||||||||
White | 6,340 | 64.6 | 3,472 | 35.2 | 1.33 | 1.20–1.47 | 692 | 11.9 | 315 | 10.8 | 1.06 | .91–1.23 |
Black | 1,313 | 54.9 | 1,077 | 45.1 | 1.00 | 152 | 12.6 | 112 | 12.0 | 1.03 | .77–1.37 | |
Hispanic | 93 | 63.3 | 54 | 36.7 | 1.35 | .93–1.95 | 10 | 11.6 | 6 | 14.6 | .07 | .01–.88 |
Other | 664 | 57.2 | 496 | 42.8 | 1.04 | .98–1.21 | 75 | 12.5 | 38 | 9.8 | 1.29 | .80–2.06 |
Mental Health Follow-Up Outpatient Visits and Hospital Readmission
30-day follow-up visit | No 30-day follow-up visit | ||||||
---|---|---|---|---|---|---|---|
Variable | N | % | N | % | p | AOR | 95% CI |
Total | 1,921 | 13.0 | 1,013 | 13.1 | .831 | .88 | .81–.96 |
Age | |||||||
18–24 | 413 | 15.2 | 220 | 16.4 | .317 | .80 | .67–.97 |
25–35 | 510 | 14.0 | 279 | 14.4 | .684 | .88 | .74–1.04 |
36–45 | 353 | 12.3 | 198 | 13.0 | .500 | .88 | .72–1.07 |
46–64 | 645 | 11.7 | 316 | 10.8 | .239 | .94 | .81–1.10 |
Sex | |||||||
Female | 838 | 12.6 | 384 | 12.5 | .797 | .87 | .76–1.00 |
Male | 1,083 | 13.3 | 629 | 13.6 | .708 | .88 | .79–.98 |
Payment source | |||||||
Medicaid | 1,306 | 13.6 | 668 | 12.9 | .245 | .95 | .85–1.06 |
Commercial insurance | 615 | 11.9 | 345 | 13.5 | .046 | .76 | .65–.88 |
Subtype, index admission | |||||||
Schizoaffective | 1,039 | 14.2 | 474 | 14.2 | .960 | .90 | .80–1.02 |
Other schizophrenia | 882 | 11.9 | 539 | 12.3 | .455 | .86 | .76–.98 |
Length of index admission (days) | |||||||
Short (1–8) | 1,134 | 13.1 | 594 | 12.6 | .416 | .94 | .84–1.05 |
Medium (9–12) | 395 | 13.0 | 214 | 13.4 | .739 | .87 | .72–1.05 |
Long (13–30) | 392 | 12.9 | 205 | 14.7 | .102 | .73 | .61–.89 |
Substance use disorder in past 120 days | |||||||
Present | 601 | 15.6 | 366 | 16.2 | .545 | .87 | .75–1.01 |
Absent | 1,320 | 12.1 | 647 | 11.8 | .635 | .88 | .80–.98 |
Use of mental health services in past 120 days | |||||||
Inpatient | 243 | 23.0 | 110 | 21.6 | .547 | 1.07 | .82–1.40 |
Emergency department | 606 | 14.8 | 304 | 14.7 | .939 | .93 | .79–1.08 |
Mental health professional | 1,753 | 13.7 | 674 | 14.4 | .238 | .93 | .84–1.02 |
No use of mental health services in past 120 daysb | 168 | 8.4 | 339 | 11.1 | .002 |
30-day follow-up visit | No 30-day follow-up visit | ||||||
---|---|---|---|---|---|---|---|
Variable | N | % | N | % | p | AOR | 95% CI |
Total | 2,859 | 10.1 | 1,164 | 10.5 | .296 | .91 | .85–.98 |
Age | |||||||
18–24 | 761 | 11.9 | 322 | 10.6 | .068 | 1.01 | .87–1.16 |
25–35 | 615 | 10.1 | 243 | 9.9 | .734 | .97 | .83–1.15 |
36–45 | 592 | 9.7 | 231 | 10.5 | .289 | .93 | .79–1.11 |
46–64 | 891 | 9.2 | 368 | 10.8 | .008 | .77 | .67–.88 |
Sex | |||||||
Female | 1,819 | 10.0 | 658 | 10.1 | .785 | .92 | .83–1.01 |
Male | 1,040 | 10.3 | 506 | 10.9 | .233 | .90 | .80–1.02 |
Payment source | |||||||
Medicaid | 929 | 12.1 | 471 | 11.0 | .091 | 1.06 | .94–1.20 |
Commercial insurance | 1,930 | 9.4 | 693 | 10.1 | .072 | .83 | .76–.92 |
Subtype, index admission | |||||||
Depressed | 1,338 | 10.5 | 507 | 10.3 | .638 | .97 | .83–1.08 |
Manic | 586 | 8.7 | 276 | 10.8 | .003 | .73 | .63–.86 |
Mixed | 799 | 10.5 | 306 | 10.1 | .607 | 1.01 | .87–1.17 |
Other | 136 | 11.4 | 75 | 12.6 | .464 | .85 | .61–1.18 |
Length of admission (days) | |||||||
Short (1–8) | 1,938 | 9.6 | 837 | 10.0 | .251 | .92 | .84–1.00 |
Medium (9–12) | 542 | 11.0 | 199 | 11.7 | .451 | .89 | .74–1.06 |
Long (13–30) | 379 | 12.1 | 128 | 12.0 | .907 | .92 | .73–1.15 |
Substance use disorder in past 120 days | |||||||
Present | 882 | 12.1 | 475 | 13.2 | .098 | .88 | .77–.99 |
Absent | 1,977 | 9.4 | 689 | 9.2 | .499 | .94 | .85–1.04 |
Use of mental health services in past 120 days | |||||||
Inpatient | 507 | 19.0 | 201 | 22.0 | .048 | .82 | .67–1.00 |
Emergency department | 711 | 11.0 | 314 | 13.1 | .005 | .81 | .70–.94 |
Mental health professional | 2,502 | 10.7 | 786 | 11.8 | .010 | .92 | .84–1.00 |
No use of mental health services in past 120 daysb | 357 | 7.3 | 378 | 8.4 | .033 |
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