The Effectiveness of Discharge Planning for Psychiatric Inpatients With Varying Levels of Preadmission Engagement in Care

Abstract

Objective: This study examined the extent to which prehospital treatment engagement is related to posthospital follow-up treatment among psychiatric inpatients and whether the effects of inpatient discharge planning on posthospital follow-up treatment vary by level of pretreatment engagement in care.

Methods: New York State Medicaid and other administrative databases were used to examine service use by 18,793 adult patients discharged to the community after inpatient psychiatric care in 2012-2013. Outcomes included attending an outpatient mental health service within 7 days and within 30 days after discharge. The sample was stratified by whether patients had high, partial, low, or no engagement in outpatient psychiatric services in the 6 months before admission.

Results: Scheduling an outpatient appointment as part of the patient's discharge plan was significantly associated with attending outpatient psychiatric appointments, regardless of the patient's level of engagement in care before admission. The differences were most pronounced for patients who had not received any outpatient care in the 6 months before admission. When an appointment was scheduled, these patients were three times more likely to follow up with care within 7 days and more than twice as likely to follow up within 30 days than were patients without a scheduled appointment.

Conclusions: The likelihood of psychiatric inpatients following up with outpatient psychiatric care was directly related to their level of outpatient care engagement before hospital admission. Even among those who had not been engaged in outpatient care, inpatient discharge planning was associated with a greater likelihood of receiving follow-up outpatient care.

Keywords: Care transitions; discharge planning; engagement; follow-up after hospitalization; hospital psychiatric care; scheduling appointments.

Figure 1.

Seven- and 30-day rates of attending outpatient mental health care following discharge among patients who had high, partial, low, and no engagement in care prior to admission

Figure 2.

Proportions of patients attending an outpatient mental health appointment within 7 days following discharge based upon level of pre-admission engagement in care and receipt of discharge planning.

Figure 3.

Proportions of patients attending an outpatient mental health appointment within 30 days following discharge based upon level of pre-admission engagement in care and receipt of discharge planning.