Dr. Jie Chen
December 15, 2017

More than half of preventable hospitalizations in Maryland are for people with co-existing mental health and chronic physical conditions. A new study by School of Public Health researchers suggests that low-cost mental health programs provided by local health departments can play a critical role in preventing these costly and unnecessary hospitalizations.

“Unfortunately, we see a lot of people with chronic conditions like asthma, heart disease, and diabetes who are also suffering from a mental health issue,” says Dr. Jie Chen, associate professor of health services administration and lead author of the study published in the American Journal of Preventive Medicine. “Racial and ethnic minorities experience a disproportionate burden of these co-existing conditions, largely due to a lack of healthcare access and the social stigma associated with mental illness. When local health departments provide mental health preventive care, we see significantly lower rates of inpatient hospital admissions for people with chronic physical conditions and coexisting mental disorders such as substance abuse, depression and anxiety.”

The data analysis of Dr. Chen and colleagues also found that African Americans were less likely than whites to live in the counties with the local health departments that were actively providing mental health preventive care. “If African American populations receive mental health services from their local health department, it could yield a 9% reduction in preventable hospitalizations for this group,” Dr. Chen says.

In recent years, many efforts to improve health care delivery nationwide have made the integration of mental health and wellness services a priority. Coordination between hospital systems and public health departments can address some of the root causes of poor health by improving healthcare access, reducing social stigma, and reducing health disparities, the paper explains. The mental health care system has historically worked in a silo and has not been connected to rest of health system, but this is changing.

“The health departments can play a very important role in promoting community mental health. Maryland has a great opportunity to involve local health departments in integrated healthcare delivery with the goal of improving mental health for its most vulnerable populations,” Dr. Chen suggests.

Dr. Chen’s research team analyzed multiple data sets from 2012-2013, including the Healthcare Cost and Utilization Project State Inpatient Databases of the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the American Hospital Directory, the Area Health Resource File, and U.S. Census data (this study was supported by NIMH, R21MH106813-01, Chen, PI). She acknowledges that prevention and education efforts by Maryland’s 24 county health departments, implemented since that time, may have helped to further reduce preventable hospitalizations.

Results of this study can guide policy decisions at the federal, state, and local level since it provides concrete evidence of the value of local health departments in achieving care integration to improve mental health.

With recently secured funding from the National Institutes of Health (1R01MD011523-01, Chen, PI), Dr. Chen developed the Project System-level Multidisciplinary Integration for popuLation health and Equity (SMILE) which will expand this study to examine national data. The objective is to estimate the impact of multi-level care coordination (i.e., adoption of care coordination strategies, engagement in PCMHs, formation of clinically integrated networks, and participation in Accountable Care Organizations) on racial and ethnic disparities in health care with a focus on high risk populations. She and her co-investigators expect to identify specific combinations of care coordination practices (e.g., integrating physical and behavioral health, sharing clinical information across health sectors) and public health programs (e.g., mental health prevention interventions, transportation, public housing) that work best for minority populations with mental illness. 

Article Link: 
Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities
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