Care Management Intervention to Decrease Psychiatric and Substance Use Disorder Readmissions in Medicaid-Enrolled Adults

  • Shari L. Hutchison
  • Jenny V. Flanagan
  • Irina Karpov
  • Lisa Elliott
  • Brandi Holsinger
  • Jamie Edwards
  • David Loveland
Article
  • 28 Downloads

Abstract

This study examines the generalizability of a successful care management bridging strategy implemented by a behavioral health managed care organization to reduce readmission in psychiatric and substance use disorder (SUD) populations. The sample included 1724 individuals with a psychiatric or SUD hospitalization or detoxification service within 30-days of a prior SUD or inpatient event; 1243 Medicaid-enrolled adults received the intervention plus usual care, and 481 individuals received only usual care. Results included lower readmission to SUD facilities (p = .0012) and reduced odds of readmission among individuals with a SUD event (OR = 0.49, p = .0006) for the intervention versus the comparison group. Likelihood of readmission was higher for those with dual diagnoses (OR = 1.72, p = .0002) or in urban settings (OR = 1.47, p = .0010), with some evidence of the intervention’s success in these populations. Care management bridging strategies may be more effective for individuals who utilize SUD services and others who need help navigating complex systems of care.

Keywords

Mental health Substance use disorders Readmission Medicaid Managed care Social determinants 

Notes

Acknowledgements

The authors wish to thank Carole Taylor, Community Care Behavioral Health Organization, for development of the care management intervention; Amanda Allen, Karen Mallah, Tammy Pooler, and Tiffany Thomas, Community Care Behavioral Health Organization; and Advocates for Human Potential, Sudbury, MA, for feedback and editorial contributions to this manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    National Council for Quality Assurance. HEDIS 2018, Volume 2: Summary table of measures, product lines, and changes. Available online at https://www.ncqa.org/Portals/0/HEDISQM/HEDIS2017/HEDIS%202017%20Volume%202%20List%20of%20Measures.pdf?ver=2016-06-27-135433-350. Accessed on July 26, 2017.
  2. 2.
    Pennsylvania Department of Human Services. Medical assistance quality strategy for Pennsylvania. Available online at http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_260569.pdf. Published on April 20, 2017. Accessed on July 26, 2017.
  3. 3.
    Hines AL, Barrett ML, Jiang HJ, et al. Conditions with the largest number of adult hospital readmissions by payer, 2011. HCUP Statistical Brief #172. April 2014. Agency for Healthcare Research and Quality, Rockville, MD. Available online at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf. Accessed on February 12, 2018.
  4. 4.
    The Kaiser Commission on Medicaid and the Uninsured. Medicaid enrollees are sicker and more disabled than the privately-insured. Available online at https://www.kff.org/medicaid/slide/medicaid-enrollees-are-sicker-and-more-disabled-than-the-privately-insured/. Accessed on February 12, 2018.
  5. 5.
    Busch AB, Epstein AM, McGuire TG, et al. Thirty day hospital readmission for Medicaid Enrollees with schizophrenia: The role of local health care systems. Journal of Mental Health Policy and Economics. 2015;18(3):115–124.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Substance Abuse and Mental Health Services Administration. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. NSDUH, HHS Publication No. SMA 15–4927, Rockville, MD: Center for Behavioral Health Statistics and Quality, 2015.Google Scholar
  7. 7.
    Boaz TL, Becker MA, Andel R, et al. Risk factors for early readmission to acute care for persons with schizophrenia taking antipsychotic medications. Psychiatric Services. 2010;64(12):1225–1229.CrossRefGoogle Scholar
  8. 8.
    Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Agency for Healthcare Research and Quality. HCUP Statistical Brief #153. Rockville, MD: US Department of Health and Human Services, 2013.Google Scholar
  9. 9.
    Lorine K, Goenjian H, Kim S, et al. Risk factors associated with psychiatric readmission. Journal of Nervous & Mental Disease. 2015;203:425–430.CrossRefGoogle Scholar
  10. 10.
    Mark T, Kowlessar N, Vandivort-Warren R. Hospital readmission among Medicaid patients with an index hospitalization for mental and/or substance use disorder. Journal of Behavioral Health Services & Research. 2013;40(2):207–221.CrossRefGoogle Scholar
  11. 11.
    Prince JD, Akincigil A, Hoover DR, et al. Substance abuse and hospitalization for mood disorder among Medicaid beneficiaries. American Journal of Public Health. 2009;99(1):160–167.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Smith MW, Stocks C, Santora PB. Hospital readmission rates and emergency department visits for mental health and substance abuse conditions. Community Mental Health Journal. 2015;51:190–197.CrossRefPubMedGoogle Scholar
  13. 13.
    Molfenter T, Connor T, Ford JH, et al. Reducing psychiatric inpatient readmissions using an organizational change model. WMJ: Official Journal of the Wisconsin Medical Society. 2016;115(3):122–128.Google Scholar
  14. 14.
    Raven M, Carrier E, Lee J, et al. Substance use treatment barriers for patients with frequent hospital admissions. Journal of Substance Abuse Treatment. 2010;38(1):22–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Acevedo A, Garnick D, Ritter G, et al. Admission to detoxification after treatment: Does engagement make a difference? Substance Abuse. 2016;37(2):364–371.CrossRefPubMedGoogle Scholar
  16. 16.
    Ilgen MA, Unger Hu K, Moos RH, et al. Continuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders. Psychiatric Services. 2008;59:982–988.CrossRefPubMedGoogle Scholar
  17. 17.
    Suzuki Y, Yasumura S, Fukao A, et al. Associated factors of rehospitalization among schizophrenic patients. Psychiatry and Clinical Neurosciences. 2003;57:555–561.CrossRefPubMedGoogle Scholar
  18. 18.
    Herman D, Opler L, Felix A, et al. A critical time intervention with mentally ill homeless men: impact on psychiatric symptoms. The Journal of Nervous and Mental Disease. 2000;188(3):135–140.CrossRefPubMedGoogle Scholar
  19. 19.
    Herman D, Conover S, Felix A, et al. Critical Time Intervention: an empirically supported model for preventing homelessness in high risk groups. The Journal of Primary Prevention. 2007;28(3–4):295–312.CrossRefPubMedGoogle Scholar
  20. 20.
    Susser E, Valencia E, Conover S, et al. Preventing recurrent homelessness among mentally ill men: a “critical time” intervention after discharge from a shelter. American Journal of Public Health. 1997;87(2):256–262.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Dixon L, Goldberg R, Iannone V, et al. Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatric Services. 2009;60(4):451–458.CrossRefPubMedGoogle Scholar
  22. 22.
    Shaffer SL, Hutchison SL, Ayers AA, et al. Brief Critical Time Intervention to improve psychiatric readmission. Psychiatric Services 2015;66(11):1155–1161.CrossRefPubMedGoogle Scholar
  23. 23.
    Bonsack C, Golay P, Manetti SG, et al. Linking primary and secondary care after psychiatric hospitalization: Comparison between transitional case management setting and routine care for common mental disorders. Frontiers in Psychiatry. 2016;7. Available online at https://www.frontiersin.org/articles/10.3389/fpsyt.2016.00096/full. Accessed on March 28, 2018.
  24. 24.
    Olfson M, Mechanic D, Boyer CA, et al. Linking inpatients with schizophrenia to outpatient care. Psychiatric Services. 1998;49(7):911–917.CrossRefPubMedGoogle Scholar
  25. 25.
    Vigod SN, Kurdyak PA, Dennis CL, et al. Transitional interventions to reduce early psychiatric readmissions in adults: systematic review. The British Journal of Psychiatry. 2013;202:187–194.CrossRefPubMedGoogle Scholar
  26. 26.
    Acquavita SP, Stershic S, Sharma R, et al. Client incentives versus contracting and staff incentives: how care continuity interventions in substance abuse treatment can improve residential to outpatient transition. Journal of Substance Abuse Treatment. 2013;45(1):55–62.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Carroll CP, Triplett PT, Mondimore FM. The Intensive Treatment Unit: a brief inpatient detoxification facility demonstrating good postdetoxification treatment entry. Journal of Substance Abuse Treatment. 2009;37(2):111–119.CrossRefPubMedGoogle Scholar
  28. 28.
    Schaefer JA, Cronkite RC, Hu KU. (2011). Differential relationships between continuity of care practices, engagement in continuing care, and abstinence among subgroups of patients with substance use and psychiatric disorders. Journal of Studies on Alcohol and Drugs. 2011;72:611–621.Google Scholar
  29. 29.
    Schaefer JA, Harris AHS, Cronkite RC, et al. Treatment staff’s continuity of care practices, patients’ engagement in continuing care, and abstinence following outpatient substance use disorder treatment. Journal of Studies on Alcohol and Drugs. 2008;69:747–756.CrossRefPubMedGoogle Scholar
  30. 30.
    Timko C, Below M, Schultz NR, et al. Patient and program factors that bridge the detoxification-treatment gap: a structured evidence review. Journal of Substance Abuse Treatment. 2015;52:1–9.CrossRefGoogle Scholar
  31. 31.
    Taylor C, Holsinger B, Flanagan, JV, et al. (2014). Effectiveness of a Brief Care Management Intervention for Reducing Psychiatric Hospitalization Readmissions. Journal of Behavioral Health Services & Research ;43(2):262–271.CrossRefGoogle Scholar
  32. 32.
    Health Resources and Services Administration. U.S. Department of Health & Human Services. Designated Health Professional Shortage Areas Statistics as of February 3, 2018. Available at https://datawarehouse.hrsa.gov/Tools/HDWReports/Reports.aspx. Accessed on February 13, 2018.
  33. 33.
    Durbin J, Lin E, Layne C, et al. Is readmission a valid indicator of the quality of inpatient psychiatric care? The Journal of Behavioral Health Services & Research. 2007;34(2):137–150.CrossRefGoogle Scholar
  34. 34.
    Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression, 3rd edition. Hoboken, New Jersey: Wiley, 2013.CrossRefGoogle Scholar
  35. 35.
    Ambrosius WT. Topics in biostatistics. New York, NY: Humana Press, 2007.CrossRefGoogle Scholar
  36. 36.
    Cox DR, Snell EJ. The analysis of binary data, 2nd edition. London: Chapman and Hall, 1989.Google Scholar
  37. 37.
    Nagelkerke NJD. A note on a general definition of the coefficient of determination. Biometrika. 1991;78(3):691–692.CrossRefGoogle Scholar
  38. 38.
    SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc. in the USA and other countries. ® indicates USA registration.Google Scholar

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  • Shari L. Hutchison
    • 1
  • Jenny V. Flanagan
    • 1
  • Irina Karpov
    • 1
  • Lisa Elliott
    • 1
  • Brandi Holsinger
    • 1
  • Jamie Edwards
    • 1
  • David Loveland
    • 1
  1. 1.Community Care Behavioral Health OrganizationPittsburghUSA

Personalised recommendations