After psychiatric hospitalization, follow-up appointments are key for helping patients re-acclimate to normal life, manage their medications and avoid readmission. But not all hospitals are successful at getting their patients to engage in follow-up treatment.
Associate Professor Jie Chen and doctoral student Ivy Benjenk examined two factors that can affect hospitals’ follow-up rates: the hospitals’ organizational structures and the neighborhoods they serve.
Analyzing 7- and 30-day mental health follow-up rates among Medicare recipients, most of whom are over 65, for different hospitals in 2015, the researchers found that those hospitals located in neighborhoods with high proportions of minority residents or residents living in poverty had lower follow-up rates, as did hospitals associated with larger health systems, public hospitals, psychiatric specialty hospitals and for-profit hospitals.
“Across the board, hospitals in minority communities are performing much worse on this measure,” Benjenk said. “There’s some evidence that for-profit, system and public hospitals are more likely to be low-performers, too.”
Minority communities often face disadvantages like fewer providers and greater stigma for seeking mental healthcare, and the study’s results suggest that state and local health departments must ensure they are meeting the needs of those neighborhoods, Benjenk said.
“It’s important for local health departments and states to look at the data and ask, ‘What can we do to support hospitals in minority communities?’” Benjenk said.
Follow-up rates are frequently used as measures of health plan and hospital quality, and facilities are expected to develop successful and comprehensive plans for follow-up after discharge. This is particularly important for the older adults studied here, who need closer medication monitoring to avoid falls and other hazards.
While minority- and low-income-focused hospitals performed worse, it’s unclear whether that is due to poorer quality care, weak infrastructure for behavioral health services in the area or social determinants of health that interfere with follow-up, the study notes.
To conduct their research, Benjenk and Chen paired the Medicare-provided follow-up data with hospital information provided by the American Hospital Association Annual Survey and Census demographics for the five-mile radius surrounding each hospital.
Hospital follow-up rates ranged from 16 to 95 percent, with an average of 56 percent. The wide range implies much room for improvement exists at many hospitals, the study notes.
The study, Variation of Follow-Up Rate After Psychiatric Hospitalization of Medicare Beneficiaries by Hospital Characteristics and Social Determinants of Health, was published in the American Journal of Geriatric Psychiatry this month.
- Department of Health Policy and Management