Sherry L Shaffer1, Shari L Hutchison1, Amanda M Ayers1, Richard W Goldberg1, Daniel Herman1, Deborah A Duch1, Jane N Kogan1, Lauren Terhorst1. 1. Ms. Shaffer, Ms. Hutchison, Ms. Ayers, and Ms. Duch are with the Community Care Behavioral Health Organization, Pittsburgh, Pennsylvania. Dr. Goldberg is with the Mental Illness Research, Education, and Clinical Center, Veterans Affairs Capitol Health Care Network, Baltimore, and with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Herman is with the Silberman School of Social Work, Hunter College, New York City. Dr. Kogan is with the Center for High-Value Health Care, University of Pittsburgh Medical Center, Pittsburgh. Dr. Terhorst is with the Department of Occupational Therapy, University of Pittsburgh. Send correspondence to Ms. Hutchison (e-mail: hutchisons@ccbh.com ).
Abstract
OBJECTIVE: The study investigated the association between implementation of a brief critical time intervention (BCTI) model and occurrence of early and long-term psychiatric readmission of adults with serious mental illness. METHODS: A sample of 149 adults with a psychiatric inpatient readmission within 30 days of a prior psychiatric hospitalization was referred to an acute level of service coordination (ASC) available at six provider organizations implementing BCTI. Activities important to the delivery of BCTI were monitored and supported. A comparison cohort of 224 adults served by ASC at the same organizations before implementation of BCTI was derived from administrative data. Frequencies of behavioral health service utilization and readmission rates for the intervention and comparison cohorts within 30 and up to 180 days of the prior readmission were compared. RESULTS: Utilization rates of mental health and substance use disorder services were similar for both cohorts postdischarge. The proportion of individuals readmitted within 30 days of a discharge was lower for the BCTI cohort (28%) than the comparison cohort (47%) (p<.001). Longer-term readmission rates also were lower in the BCTI cohort but were not significantly different from the comparison cohort (44% versus 52%). With analyses controlling for patient characteristics and service utilization, individuals in the comparison cohort were 2.83 times more likely to be readmitted within 30 days than those who received BCTI (p<.001). CONCLUSIONS: BCTI was associated with decreased early readmission rates, suggesting that this model may be an effective approach to improve continuity of care for this population.
OBJECTIVE: The study investigated the association between implementation of a brief critical time intervention (BCTI) model and occurrence of early and long-term psychiatric readmission of adults with serious mental illness. METHODS: A sample of 149 adults with a psychiatric inpatient readmission within 30 days of a prior psychiatric hospitalization was referred to an acute level of service coordination (ASC) available at six provider organizations implementing BCTI. Activities important to the delivery of BCTI were monitored and supported. A comparison cohort of 224 adults served by ASC at the same organizations before implementation of BCTI was derived from administrative data. Frequencies of behavioral health service utilization and readmission rates for the intervention and comparison cohorts within 30 and up to 180 days of the prior readmission were compared. RESULTS: Utilization rates of mental health and substance use disorder services were similar for both cohorts postdischarge. The proportion of individuals readmitted within 30 days of a discharge was lower for the BCTI cohort (28%) than the comparison cohort (47%) (p<.001). Longer-term readmission rates also were lower in the BCTI cohort but were not significantly different from the comparison cohort (44% versus 52%). With analyses controlling for patient characteristics and service utilization, individuals in the comparison cohort were 2.83 times more likely to be readmitted within 30 days than those who received BCTI (p<.001). CONCLUSIONS: BCTI was associated with decreased early readmission rates, suggesting that this model may be an effective approach to improve continuity of care for this population.
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