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State mental hospital continuity of care study: Preliminary report
Mental Health Law & Policy Faculty Publications
  • Timothy L. Boaz
  • Keith Vossberg
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This study reports on the analysis of several existing administrative data sets to examine issues related to the continuity of care in the community for persons discharged from the Florida state mental health hospitals. The validity of conclusions based on such analysis is dependent on the adequacy of the existing data. While certain types of reporting errors can be identified and remediated (to a degree), other types of errors, particularly omission of reporting, often cannot be identified or remediated. Thus, the conclusions of this report need to be taken somewhat tentatively. Persons were identified who were discharged to the community from the state mental hospitals in Florida from 7/1/98 to 12/31/99. For this preliminary report, several indicators of continuity of care and indicators of adverse outcomes were tracked for these persons. The major findings were that -- 1. A significant number of the persons in this study experienced adverse outcomes following discharge and within the time frame of the study. Nearly one sixth of the sample was readmitted to one of the state hospitals. Further, 21.3% of the sample experienced inpatient or crisis admissions in the community, and 14.5% of the sample were arrested (6.8% on felony charges) during this time frame. 2. Almost 30% of the sample had no record of non-crisis, mental health treatment services in the community during the six months following discharge. This figure probably overestimates the magnitude of the problem with follow-up care since some of the cases may have been lost to follow-up for a variety of other reasons (e.g., follow-up data not reported; data set identifiers mismatched; the person died, moved out of state, or was reinstitutionalized elsewhere; services were billed to Medicaid but not reported to the Department of Children and Families (DCF); or services were received from a provider that does not report to the DCF). It was also the case that almost 30% of the persons who were readmitted to the state hospital had no record of receiving mental health services in the community during the time between their original discharge and their subsequent readmission. 3. Of those who did receive mental health services in the community, most received case management services and those were instituted in a timely fashion. However, substantially fewer received psychiatric services, and a distinct minority of persons received residential treatment or other therapy. For those who did receive such treatment services, those services were sometimes not initiated promptly, but such services were usually provided in reasonable quantities. 4. About 70% of the sample was enrolled in Medicaid during the study period. Many of these were enrolled prior to discharge from the hospital. Enrollment in Medicaid (or lack thereof) did not appear to be related to the experience of adverse outcomes in this group. 5. Neither the latency of onset, nor the quantity of mental health services received in the community during the first six months following discharge appeared to be related to experiencing readmission or other adverse events, except that those who experienced crisis events were more likely to have received case management services in the community. 6 Several case variables were found to be associated with the experience of readmission to the state hospital or to the experience of adverse events. Specifically, persons with schizoaffective disorder were more likely than persons with other disorders to be readmitted to the hospital and to experience other adverse events. Persons who had more prior state hospital episodes were also more likely to be readmitted. Younger persons, and persons with prior arrest histories were more likely to experience adverse events. Gender and race were unrelated to readmission and to adverse event experience. A follow-up report will be prepared by June 30, 2001 regarding this sample of persons that will include analysis of Medicaid claims data (mental health, physical health, and pharmacy), data on community hospital admissions, and involuntary mental health treatment.
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Timothy L. Boaz and Keith Vossberg. "State mental hospital continuity of care study: Preliminary report" (2001)
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