Black and Native American/Alaska Native patients are less likely to attend follow-up outpatient mental health visits 30 days after discharge from hospital psychiatric units compared with White patients, according to a study published yesterday in Psychiatric Services.
“Patients who successfully transition to outpatient mental health care have a decreased risk for hospital readmission, violence, homelessness, and criminal justice involvement,” wrote Thomas Smith, M.D., of New York State Psychiatric Institute and colleagues. “However, critical disparities exist … Ethnoracially disadvantaged groups are more likely to live in communities with higher poverty levels, fewer health care providers, and greater transportation barriers that diminish access to care.”
To better understand the role of ethnoracial disparities in follow-up care after psychiatric hospitalization, Smith and colleagues analyzed data from 2012-2013 New York state Medicaid claims. The analysis included 17,488 patients who were under age 65; admitted to an inpatient psychiatric unit from 2012 to 2013 with a principal diagnosis of a mental illness; hospitalized for less than 60 days; discharged to the community; continuously enrolled in Medicaid for the 60 days after discharge; and enrolled in Medicaid before the inpatient admission. The authors looked at whether these patients attended an outpatient psychiatric service visit within seven or 30 days after their discharge. An outpatient visit was defined as a Medicaid claim for a visit at a licensed mental health outpatient setting or any outpatient service with a primary diagnosis of a mental disorder.
Further, the authors analyzed community, hospital, and patient characteristics that are believed to affect post-discharge mental health care. Some of these characteristics include rates of poverty in the community, the continuum of psychiatric services offered at the hospital, and the patient’s housing stability. They drew this data from the 2012-2013 American Hospital Association Annual Survey, the 2012-2013 Health Resources and Human Services Administration Area Resource File, and a 2012-2013 New York state managed behavioral health care organization discharge file.
Overall, 39.3% of the patients attended an outpatient mental health visit within seven days of discharge, and 60.1% of patients attended such visits within 30 days of discharge. Among Black patients, attendance was significantly lower compared with White patients, while the rate among Latinx patients did not differ significantly from that of White patients. Asian/Pacific Islander patients had the highest rate of 30-day follow-up attendance (71.9%), followed by White patients (64.1%), Latinx patients (62%), Native American/Alaska Native patients (56.2%), and Black patients (54.6%).
A community’s status as urban versus rural, as well as its poverty status, accounted for the greatest differences in follow-up attendance among the groups. Additional characteristics that were associated with lower follow-up rates included the following:
- Patients not participating in mental health care before admission.
- Patients not having an outpatient appointment scheduled during discharge planning.
- Patients being discharged from hospitals located in counties with high poverty levels or a low density of providers.
- Patients being discharged from hospitals that treat high proportions of patients with substance use disorder or who are homeless.
“Providers and policymakers need to consider important structural and cultural factors that underly social determinants of mental health and affect health care access and outcomes,” Smith and colleagues concluded.
For related information, see the Psychiatric Services article “Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care.”
(Image: iStock/Prostock-Studio)
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