Hospital Discharge Planning and Transition to Outpatient Psychiatric Care

出院计划和过渡到门诊精神科护理

• 批准号: 9028397
• 负责人: THOMAS E SMITH
• 金额: $ 56.17万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9028397
• 关键词: Acute; Address; Admission activity; Aftercare; Age; Ambulatory Care; Appointment; Businesses; Caring; Case Management; Characteristics; Clinical; Contracts; Criminal Justice; Data; Databases; Development; Disease; Educational process of instructing; Effectiveness; Ensure; Failure; Fee-for-Service Plans; Health Personnel; Healthcare; Hospitalization; Hospitals; Income; Intervention; Link; Managed Care; Measures; Medicaid; Medical; Mental Health; New York; Outpatients; Patients; Performance; Population; Population Density; Provider; Psychiatric Hospitals; Psychiatric therapeutic procedure; Publishing; Readiness; Recording of previous events; Relapse; Reporting; Resources; Schedule; Services; Site; Subgroup; Substance Use Disorder; Suicide; System; Time; United States Centers for Medicare and Medicaid Services; Vulnerable Populations; Youth; administrative database; adverse outcome; behavioral health; clinical practice; design; follow-up; health organization; hospital readmission; housing instability; improved; outreach; programs; public health relevance; relapse risk; routine care; safety net; standard of care; web site

 DESCRIPTION (provided by applicant): Fifty percent of Medicaid patients treated on hospital psychiatric units fail to attend a follow-up outpatient service within 30 days of discharge. These failed care transitions increase the risk of relapse, readmission, criminal justice involvement, and suicide. Hospital care transition practices meant to facilitate transitions include communicating with outpatient mental health providers, scheduling timely post-discharge outpatient appointments, and forwarding treatment summaries to outpatient providers. These practices represent a standard of care and are included in many new public reporting and pay-for-performance programs. However, surprisingly little is known about how often hospital providers complete these practices, which practices are more critical than others, and for which patients these practices may not be sufficient to ensure follow-up. The proposed project addresses these questions by examining hospital care transition practices for over 30,000 Medicaid discharges from more than 100 hospital psychiatric units throughout New York State (NYS) in 2012 - 2013. As part of a statewide managed care readiness program, hospitals were required to notify a contracted managed behavioral health organization (MBHO) of Medicaid fee-for-service admissions to a hospital psychiatric unit and report whether they: 1) communicated with current or prior outpatient mental health providers; 2) scheduled a follow-up appointment with an outpatient provider; and 3) forwarded a case summary to the outpatient provider. The proposed project combines data from MBHOs with Medicaid claims data and information on hospital, outpatient provider, and regional service system characteristics. We will determine the rates at which hospital providers completed each of the three care transition practices and identify characteristics of patients that did and did not receive each practice. We will then determine the effectiveness of the care transition practices after controlling for patien characteristics (e.g., co-morbid general medical or substance use disorders, lack of contact with providers prior to admission), hospital characteristics (e.g., size, teaching status, presence of on-site outpatient services), characteristics of outpatient providers receiving referrals (e.g., sie, type, availability of care management supports), and regional service system characteristics (e.g., provider capacity, population density, per capita income) known to impact care transitions. We will determine whether the care transition practices were effective in high-need subgroups such as youth, patients with prior failure to attend outpatient care or frequent use of hospital services, and patients with co- morbid general medical disorders. Finally, we will identify patient subgroups for which the practices were insufficient and that are likely to require more intensive approaches to ensure successful care transitions. Findings from this project will guide provider efforts to improve care transitions, provide validity data for potential new quality measures related to mental health care transitions, and inform system level quality improvement initiatives that will further strengthen safety net services for Medicaid patients.

 描述（由申请人提供）：在医院精神科接受治疗的医疗补助患者中，有50%未能在出院后30天内参加后续门诊服务。这些失败的护理过渡增加了复发，再入院，刑事司法参与和自杀的风险。旨在促进过渡的医院护理过渡实践包括与门诊心理健康提供者沟通，及时安排出院后门诊预约，并将治疗摘要转发给门诊提供者。这些做法代表了一种护理标准，并被纳入许多新的公共报告和按绩效付费计划。然而，令人惊讶的是，人们对医院提供者完成这些实践的频率、哪些实践比其他实践更重要以及对于哪些患者来说，这些实践可能不足以确保随访知之甚少。拟议的项目通过检查2012 - 2013年整个纽约州（NYS）100多个医院精神科的30，000多名医疗补助出院者的医院护理过渡实践来解决这些问题。作为全州管理式护理准备计划的一部分，医院被要求通知一个签约的管理式行为健康组织（MBHO）医疗补助按服务收费的住院精神科，并报告他们是否：1）与当前或以前的门诊心理健康提供者沟通; 2）安排与门诊提供者的随访预约; 3）将病例摘要转发给门诊提供者。拟议的项目结合了医疗保健组织的数据与医疗补助索赔数据和信息的医院，门诊提供者和区域服务系统的特点。我们将确定医院提供者完成三种护理过渡实践的比率，并确定接受和未接受每种实践的患者的特征。然后，我们将在控制患者特征（例如，共病的一般医学或物质使用障碍，入院前缺乏与提供者的接触），医院特征（例如，规模、教学状况、现场门诊服务的存在），接受转诊的门诊提供者的特征（例如，护理管理支持的SIE、类型、可用性），以及区域服务系统特性（例如，提供者能力、人口密度、人均收入），已知会影响护理过渡。我们将确定护理过渡实践在高需求亚组中是否有效，如青年、既往未能参加门诊护理或频繁使用医院服务的患者以及合并全身性疾病的患者。最后，我们将确定患者 这类群体的做法不充分，可能需要更密集的方法来确保成功的护理过渡。该项目的调查结果将指导提供者努力改善护理过渡，为与心理健康护理过渡相关的潜在新质量措施提供有效性数据，并为系统级质量改进计划提供信息，这些计划将进一步加强医疗补助患者的安全网服务。