One-year cost implications of using mental health care after discharge from a general medical hospitalization.

OBJECTIVE: The purpose of this study was to direct attention to mental health issues that may occur around discharge of patients hospitalized for general medical issues. This study provides a methodology and tested whether postdischarge mental health care moderates the effect of the length of the medical inpatient stay on costs one year later.
METHODS: Veterans Health Administration administrative data were drawn from four time periods: one year before admission, an inpatient stay, 30 days postdischarge, and the year after discharge. The cohort included 21,716 patients actively engaged in primary care with and without reliably established mental health diagnoses and who were hospitalized for a general medical issue but had no inpatient utilization in the prior year. Generalized linear models were estimated to determine the impact of administrative measures on postdischarge costs.
RESULTS: Postdischarge mental health care in the 30 days after discharge was found to interact with length of stay, as hypothesized. Postdischarge mental health care was most important for patients with moderate utilization costs in the year after discharge (a proxy for disease severity). Length of stay was negatively related to costs for patients with postdischarge mental health care and positively related to costs for patients with mental health diagnoses who did not receive postdischarge mental health care.
CONCLUSIONS: Results provide initial support to the hypothesis that postdischarge mental health care is an important factor after inpatient general medical care. Results suggest that hospitals should screen all general medical patients for psychiatric problems and ensure that postdischarge mental health care is available. Implications for future research on mental health in primary care and possibly preventable readmission are discussed.