CLEARWATER BEACH, Fla., April 14 Continuity of care for patients with schizophrenia and other serious mental illnesses is often suboptimal, despite its recognized importance. A new retrospective outcomes study, "Continuity of Care in Patients with Schizophrenia and Schizoaffective Disorder," presented this week at the Quality of Behavioral Healthcare Conference, reveals significant associations between specific interventions and improved rates of 30-day outpatient follow-up care for patients following hospitalization for schizophrenia or schizoaffective disorder.
The study found that such interventions include: direct coordination of care plans by staff at inpatient facilities with staff at outpatient facilities, inpatient facility involvement with regional joint planning efforts, and social work support for patients during the transition from inpatient care to outpatient care.
"The interventions shown to be associated with high rates of follow-up care are administrative coordination between the discharging and receiving mental health units that is modest in cost and within the means of most psychiatric units in community treatment systems," said Jean-Pierre Lindenmayer, MD, study co-author and Director, Psychopharmacology Research Unit, Nathan Kline Institute for Psychiatric Research, Manhattan Psychiatric Center, New York, N.Y.
The study authors used data from a retrospective record review of care provided to patients with schizophrenia or schizoaffective disorder, who had been hospitalized for psychiatric care in Missouri and New York state. The study described prevailing patterns of continuity of care for these patients by assessing the percentage of patients receiving outpatient follow-up care within 30 days of inpatient discharge. The authors studied patient factors and facility and system processes associated with receipt of follow-up care within 30 days.
Results: Processes Associated with Improved Rates of Follow-Up Care
Among the 240 patients included in this analysis, 73 percent had recovery plans in place at the time of discharge, 41 percent received social work support during the transition from inpatient to outpatient care, 29 percent received supportive housing resources and 11 percent participated in a peer-group support program.
Three facility-level processes were observed to be significantly associated with improved rates of receiving follow-up care within 30 days of patients being discharged from inpatient settings:
The study authors have concluded that future research should examine specific components of these processes to identify best practices to bolster continuity of care for patients with schizophrenia and schizoaffective disorder.
Data for this study were collected through retrospective medical record review and survey interviews with directors of participating inpatient mental health facilities. Medical records from a total of 240 consecutively discharged patients were reviewed to create the data set. They included 30 patient records from each of the eight inpatient facilities that participated in the analysis, four in Missouri and four in New York state.
Participating facilities in each state included a state-operated inpatient facility as well as both urban and rural not-for-profit community hospitals with psychiatric units. Continuity of care processes between the inpatient and outpatient settings were studied. The primary continuity of care-related outcome assessed in this study was receipt of follow-up outpatient psychiatric care within 30 days of the inpatient discharge.
This study was supported by Ortho-McNeil Janssen Scientific Affairs, L.L.C. Other organizations involved include Health Research Associates, Seattle, Wash.; Missouri Institute of Mental Health Research Associates, Jefferson City, Mo.; Manhattan Psychiatric Center, Nathan Kline Institute for Psychiatric Research, New York, N.Y.; National Association of County Behavioral Health and Developmental Disability Directors, Washington, D.C. Dr. Lindenmayer and all of these organizations are paid consultants for Ortho-McNeil Janssen Scientific Affairs, L.L.C.
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-- Rates of 30-day follow up were significantly higher among patients who received social work support during the transition from inpatient to ambulatory care settings. Eighty percent of patients with social work support during this period of time had confirmed follow-up care within 30 days, compared to just 68 percent of patients without social work support (p < 0.05). -- Of patients discharged from facilities with facility-level protocols for the transfer of care plans to outpatient providers, 83 percent received 30-day follow-up care, compared to 55 percent of patients discharged from other facilities (p < 0.01). -- Patients discharged from inpatient facilities that participated in regional joint planning efforts were significantly more likely to receive follow-up care within 30 days than patients receiving care at institutions that did not participate in such efforts (100 percent versus 69 percent , p <0.01).
SOURCE Ortho-McNeil Janssen Scientific Affairs