Jie Chen1, Robin Bloodworth2, Priscilla Novak2, Benjamin Le Cook3, Howard H Goldman4, Michael S Rendall5, Stephen B Thomas6, Charles F Reynolds7. 1. Department of Health Services and Administration, School of Public Health, University of Maryland, College Park, Maryland. Electronic address: jichen@umd.edu. 2. Department of Health Services and Administration, School of Public Health, University of Maryland, College Park, Maryland. 3. Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts. 4. Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland. 5. Department of Sociology, University of Maryland, College Park, Maryland; Maryland Population Research Center, University of Maryland, College Park, Maryland. 6. Department of Health Services and Administration, School of Public Health, University of Maryland, College Park, Maryland; Maryland Population Research Center, University of Maryland, College Park, Maryland; Maryland Center for Health Equity, University of Maryland, College Park, Maryland. 7. Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
INTRODUCTION: Serving as the center of community-engaged health programs, local health departments can play a critical role in promoting community mental health. The objectives of this study were to explore the association between local health department activities and (1) preventable hospitalizations for individuals with mental disorders, and (2) associated racial disparities in preventable hospitalizations. METHOD: Employing the linked data sets of the 2012-2013 Healthcare Cost and Utilization Project state inpatient discharge file of the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Resource File, and U.S. Census data, the authors estimated the association between local health department activities (i.e., provision of mental health preventive care and community mental health promotion) and the reduction of the preventable hospitalizations for ambulatory care-sensitive conditions and coexisting mental disorders. All the data analyses were conducted during September 2016-August 2017. RESULTS: Multilevel regression showed that local health departments' provision of mental health preventive care (OR=0.76, 95% CI=0.63, 0.92) and mental health promotion activities (OR=0.77, 95% CI=0.62, 0.94) were significantly associated with lower rates of preventable hospitalizations for individuals with ambulatory care-sensitive conditions and coexisting mental disorders. Decomposition results suggested that local health departments' direct provision of mental health preventive care could reduce 9% of the racial disparities. CONCLUSIONS: Improving care coordination and integration are essential to meeting the growing demands for healthcare access, while controlling costs and improving quality of service delivery. These results suggest that it will be effective to engage local health departments in the integrated behavioral health system.
INTRODUCTION: Serving as the center of community-engaged health programs, local health departments can play a critical role in promoting community mental health. The objectives of this study were to explore the association between local health department activities and (1) preventable hospitalizations for individuals with mental disorders, and (2) associated racial disparities in preventable hospitalizations. METHOD: Employing the linked data sets of the 2012-2013 Healthcare Cost and Utilization Project state inpatient discharge file of the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Resource File, and U.S. Census data, the authors estimated the association between local health department activities (i.e., provision of mental health preventive care and community mental health promotion) and the reduction of the preventable hospitalizations for ambulatory care-sensitive conditions and coexisting mental disorders. All the data analyses were conducted during September 2016-August 2017. RESULTS: Multilevel regression showed that local health departments' provision of mental health preventive care (OR=0.76, 95% CI=0.63, 0.92) and mental health promotion activities (OR=0.77, 95% CI=0.62, 0.94) were significantly associated with lower rates of preventable hospitalizations for individuals with ambulatory care-sensitive conditions and coexisting mental disorders. Decomposition results suggested that local health departments' direct provision of mental health preventive care could reduce 9% of the racial disparities. CONCLUSIONS: Improving care coordination and integration are essential to meeting the growing demands for healthcare access, while controlling costs and improving quality of service delivery. These results suggest that it will be effective to engage local health departments in the integrated behavioral health system.
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