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Research ArticleOriginal Research

Timely Outpatient Follow-up Is Associated with Fewer Hospital Readmissions among Patients with Behavioral Health Conditions

Nadereh Pourat, Xiao Chen, Shang-Hua Wu and Anna C. Davis
The Journal of the American Board of Family Medicine May 2019, 32 (3) 353-361; DOI: https://doi.org/10.3122/jabfm.2019.03.180244
Nadereh Pourat
Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA (NP, XC); UnitedHealthcare, Edina, MN (S-HW), Kaiser Permanente Center for Effectiveness and Safety Research, Oakland, CA (ACD).
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Xiao Chen
Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA (NP, XC); UnitedHealthcare, Edina, MN (S-HW), Kaiser Permanente Center for Effectiveness and Safety Research, Oakland, CA (ACD).
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Shang-Hua Wu
Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA (NP, XC); UnitedHealthcare, Edina, MN (S-HW), Kaiser Permanente Center for Effectiveness and Safety Research, Oakland, CA (ACD).
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Anna C. Davis
Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA (NP, XC); UnitedHealthcare, Edina, MN (S-HW), Kaiser Permanente Center for Effectiveness and Safety Research, Oakland, CA (ACD).
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    Figure 1.

    Criteria for inclusion in the sample and sequence of care use.

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    Table 1.

    Sample Characteristics of the Uninsured Adults with Mental Health Conditions Who Were Enrolled in the Low-Income Health Program in San Diego County from 2012 to 2013, Based on Enrollment and Claims Data

    CharacteristicOverallHad 15-Day Follow-Up VisitDid Not Have 15-Day Follow-Up VisitHad 30-Day ReadmissionDid Not Have 30-Day Readmission
    Sample size (n)1,9057961,1092511,654
    Had 15-day outpatient follow-up visit (%)42—3743
    Had 30-day readmission (%)131214——
    Utilization within six months prior to index admission
    Average number of evaluation and management visits0.660.790.560.700.65
    Average number of emergency department visits0.370.380.360.500.34
    Index admission was medical (vs. surgical) (%)6767666966
    Index admission was surgical (vs. medical) (%)3333343134
    Average number of months enrolled prior to index admission13.2513.6112.9911.9213.45
    Severity indicators
    Length of stay of index admission in days4.654.694.625.584.51
    CDPS risk score1.932.031.852.141.89
    Substance abuse (%)5650607054
    Depression (%)5556545754
    Schizophrenia (%)1210131411
    Bipolar Disorder (%)4446424843
    Demographics (%)
    Female4953474251
    Male5147535849
    Age (%)
        18 to 341612201916
        35 to 441818192018
        45 to 544141414041
        55 to 652430212125
    Race/Ethnicity (%)
        White4546454945
        African American9711710
        Latino1719161617
        Asian American/Pacific Islander45425
        Other11120
        Missing2423242524
    • CDPS (Chronic Illness and Disability Payment System) measures severity based on utilization of services with a combination of acute and chronic diagnoses.

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    Table 2.

    Marginal Effects from the Logistic Regression Models of Follow-Up Visits and Readmissions among the Uninsured Adults with Mental Health Conditions Who Were Enrolled in the Low-Income Health Program in San Diego County from 2012 to 2013, Based on Enrollment and Claims Data

    15-Day Follow-Up Visit (N = 796)30-Day Readmission (N = 251)
    Marginal EffectP value95% CIMarginal EffectP value95% CI
    Had 15-day outpatient follow-up visit———−2.5%.021[−0.05, 0.00]
    (ref. group did not have 15-day follow-up visit)
    Use within 6 months prior to index admission
    Evaluation and management visits5.8%.000[0.04, 0.08]0.9%.054[0.00, 0.02]
    Emergency department visits2.6%.194[−0.01, 0.07]3.2%.001[0.01, 0.05]
    Index admission was surgical (ref. group medical)−5.5%.059[−0.11, 0.00]−1.0%.696[−0.06, 0.04]
    Average enrollment (in months) prior to index admission0.3%.069[0.00, 0.01]−0.4%.000[−0.01, 0.00]
    Severity indicators
    Length of stay of index admission in days1.2%.001[0.00, 0.02]0.5%.039[0.00, 0.01]
    CDPS risk score2.5%.004[0.01, 0.04]1.6%.000[0.01, 0.02]
    Substance abuse−8.9%.000[−0.12, −0.06]4.9%.007[0.01, 0.09]
    Depression−0.1%.606[−0.05, 0.03]1.1%.373[−0.05, 0.00]
    Schizophrenia−4.8%.173[−0.12, 0.02]0.8%.719[−0.04, 0.05]
    Bipolar disorder4.8%.131[−0.01, 0.11]1.3%.525[−0.03, 0.05]
    Demographics
    Female2.3%.351[−0.03, 0.07]−2.4%.103[−0.05, 0.00]
    (ref. group male)
    Age (ref. group 18 to 34)
        35 to 4412.0%.000[0.07, 0.17]−0.5%.789[−0.04, 0.03]
        45 to 5410.1%.000[0.07, 0.13]−1.4%.528[−0.06, 0.03]
        55 to 6516.5%.000[0.12, 0.21]−1.4%.550[−0.06, 0.03]
    Race/ethnicity
    (ref. group white)
        African American−10.8%.007[−0.19, −0.03]−3.0%.026[−0.06, 0.00]
        Latino1.7%.520[−0.03, 0.07]−0.3%.857[−0.03, 0.03]
        Asian American0.9%.832[−0.07, 0.09]−6.5%.015[−0.12, −0.01]
        Other−5.4%.735[−0.36, 0.26]16.1%.224[−0.10, 0.42]
        Missing−1.5%.652[−0.08, 0.05]−0.2%.913[−0.04, 0.04]
    • CI, confidential interval. CDPS (Chronic Illness and Disability Payment System) measures severity based on utilization of services with a combination of acute and chronic diagnoses.

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    Appendix A.

    Multivariate Logistic Regression Results for Odds of an Outpatient Follow-Up Visits within 15 days of Discharge from the Index Hospitalization of the Uninsured Adults with Mental Health Conditions Who Were Enrolled in the Low-Income Health Program in San Diego County from 2012 to 2013, Based on Enrollment and Claims Data

    ResultOdds RatioP valueCI
    Length of stay of index admission1.07.002[1.03, 1.12]
    Length of stay of index admission–quadratic term1.00.011[1.00, 1.00]
    Chronic illness and disability payment system risk score1.11.005[1.03, 1.20]
    Female (ref. group male)1.11.347[0.90, 1.37]
    Age group (ref. group 18 to 34)
        35 to 441.71.000[1.36, 2.15]
        45 to 541.58.000[1.35, 1.85]
        55 to 652.07.000[1.72, 2.50]
    Total duration of enrollment before index admission1.01.071[1.00, 1.03]
    Index admission was surgical (ref. group medical)0.79.065[0.61, 1.01]
    Number of evaluation and management visits 6 months prior to index admission1.29.000[1.18, 1.40]
    Number of emergency department visits six months prior to index admission1.12.196[0.94, 1.34]
    Substance abuse0.68.000[0.60, 0.77]
    Depression0.96.606[0.81, 1.13]
    Schizophrenia0.81.176[0.59, 1.10]
    Bipolar disorder1.23.131[0.94, 1.61]
    Race (ref. group white)
        African American0.61.007[0.43, 0.87]
        Latino1.07.523[0.86, 1.34]
        Asian American1.04.832[0.73, 1.47]
        Other0.79.742[0.19, 3.21]
        Missing0.94.652[0.71, 1.23]
    Constant for outpatient visit model0.250.000[−1.90, −0.87]
    • CI, confidential interval.

    • View popup
    Appendix B.

    Multivariate Logistic Regression Results for Odds of All-Cause 30-Day Readmission, Regressed on Receipt of Timely Outpatient Follow-Up of the Uninsured Adults with Mental Health Conditions Who Were Enrolled in the Low-Income Health Program in San Diego County from 2012 to 2013, Based on Enrollment and Claims Data

    ResultOdds RatioP valueCI
    Timely outpatient follow-up after index admission0.79.022[0.65, 0.97]
    Length of stay of index admission1.06.044[1.00, 1.11]
    Length of stay of index admission–quadratic term1.00.054[1.00, 1.00]
    Chronic illness and disability payment system risk score1.16.000[1.08, 1.25]
    Female (ref. male)0.80.101[0.62, 1.04]
    Age group (ref. 18 to 34)
        35 to 440.95.788[0.68, 1.34]
        45 to 540.89.530[0.60, 1.30]
        55 to 650.88.533[0.58, 1.33]
    Total duration of enrollment before index admission0.97.000[0.95, 0.98]
    Index admission was surgical (ref. medical)0.89.604[0.56, 1.40]
    Number of evaluation and management visits 6 months prior to index admission1.09.053[1.00, 1.18]
    Number of emergency department visits six months prior to index admission1.34.001[1.13, 1.58]
    Substance abuse1.59.009[1.12, 1.27]
    Depression1.10.370[0.89, 1.37]
    Schizophrenia1.08.714[0.72, 1.60]
    Bipolar disorder1.12.523[0.79, 1.60]
    Race (ref. white)
    African American0.75.031[0.57, 0.97]
    Latino0.98.858[0.76, 1.26]
    Asian American0.47.059[0.22, 1.03]
    Other2.83.118[0.77, 10.44]
    Missing1.02.913[0.73, 1.41]
    Constant for outpatient visit model0.110.000[−2.97, −1.43]
    • CI, confidential interval.

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The Journal of the American Board of Family     Medicine: 32 (3)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 3
May-June 2019
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Timely Outpatient Follow-up Is Associated with Fewer Hospital Readmissions among Patients with Behavioral Health Conditions
Nadereh Pourat, Xiao Chen, Shang-Hua Wu, Anna C. Davis
The Journal of the American Board of Family Medicine May 2019, 32 (3) 353-361; DOI: 10.3122/jabfm.2019.03.180244

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Timely Outpatient Follow-up Is Associated with Fewer Hospital Readmissions among Patients with Behavioral Health Conditions
Nadereh Pourat, Xiao Chen, Shang-Hua Wu, Anna C. Davis
The Journal of the American Board of Family Medicine May 2019, 32 (3) 353-361; DOI: 10.3122/jabfm.2019.03.180244
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Keywords

  • Behavioral Medicine
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