Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?
Domino, M. E., Jackson, C., Beadles, C., Lichstein, J. C., Ellis, A. R., Farley, J. F., ... DuBard, C. A. (2015). Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions? General Hospital Psychiatry. DOI: 10.1016/j.genhosppsych.2015.11.002
OBJECTIVE: Primary-care-based medical homes may facilitate care transitions for persons with multiple chronic conditions (MCC) including serious mental illness. The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity. METHODS: Using a quasi-experimental design, we examined data from North Carolina Medicaid-enrolled adults with MCC hospitalized with an inpatient diagnosis of depression or schizophrenia during 2008-2010. We used inverse-probability-of-treatment weighting and assessed associations between medical home enrollment and outpatient follow-up within 7 and 30 days postdischarge. RESULTS: Medical home enrollees (n=16,137) were substantially more likely than controls (n= 11,304) to receive follow-up care with any provider 30 days post discharge. Increasing patient complexity was associated with a greater probability of primary care follow-up. Medical complexity and medical home enrollment were not associated with follow-up with a mental health provider. CONCLUSIONS: Hospitalized persons with MCC including serious mental illness enrolled in a medical home were more likely to receive timely outpatient follow-up with a primary care provider but not with a mental health specialist. These findings suggest that the medical home model may be more adept at linking patients to providers in primary care rather than to specialty mental health providers