Timely Outpatient Follow-up Is Associated with Fewer Hospital Readmissions among Patients with Behavioral Health Conditions

• Published in: Journal of the American Board of Family Medicine Vol. 32; no. 3; pp. 353 - 361
• Main Authors: Pourat, Nadereh, Chen, Xiao, Wu, Shang-Hua, Davis, Anna C
• Format: Journal Article
• Language: English
• Published: United States 01-05-2019
• Subjects: Logistic Regression; Outpatients; Patient Readmission; Medically Uninsured; Behavioral Medicine; Health Care Use; Hospitalization; Retrospective Studies; California
• ISSN: 1557-2625; 1558-7118
• DOI: 10.3122/jabfm.2019.03.180244

Hospital readmissions contribute to high health care costs and are an indicator of poor performance. Reducing readmissions through reconnecting patients to primary care after hospitalization is a solution that is particularly relevant to complex patients with behavioral health conditions. We therefore aimed to examine the rate of follow-up visits among patients with behavioral health conditions and to assess the impact of this visit on the subsequent rate of readmission.
In this retrospective, observational study, we analyzed data from low-income uninsured adults with behavioral health conditions (n = 1905) enrolled in a health care coverage program implemented by a California County from 2012 to 2013. We used administrative encounter and eligibility data and 2 logistic regression models to predict the (1) likelihood of a timely follow-up outpatient visit and (2) likelihood of a readmission given a timely outpatient visit. Our outcomes were to calculate the marginal effects of an outpatient visit within 15 days and a readmission within 30 days of the index admission.
The 15-day follow-up visit rate was 42% and readmission rate was 13%. Higher severity of illness (2.5%;
= .004; 95% CI, 0.01-0.04) and prior visits to providers (5.8%;
= .000; 95% CI, 0.04-0.08) increased the probability of a follow-up visit within 15 days. Follow-up visits (-2.5%;
= .021; 95% CI, -0.05-0.00) and a shorter index admission (0.5%;
= .039; 95% CI, 0.00-0.01) also reduced the risk of 30-day readmissions.
The findings provide evidence that timely linking of behavioral health patients to outpatient care after hospitalization is an effective care transition strategy, as it is likely to reduce readmission rates.