State mental hospital continuity of care study 2: Comparison of state mental hospital discharge plans with post discharge housing placements, participation in community behavioral health services, and use of psychotropic medication
Community-based care, Community psychiatric services--Planning, FMHI pubs, Case management, Discharge planning, Assessment
This study reports on the comparison of information found in on-site chart reviews conducted at four state mental hospitals in Florida with six-month post discharge follow-up data extracted from two large services data bases for Medicaid and the Department of Children and Families. The present study is a follow-up to the State Mental Hospital Continuity of Care Study, Year One Preliminary Report (Boaz & Vossberg, 2001). In that study, several administrative datasets were used to address issues in the continuity of care of 1211 persons discharged to the community from Florida state mental hospitals from July 1, 1998 through December 31, 1999. The present study seeks to further the findings of that study by conducting on-site reviews of state mental hospital medical records of a subset of 100 of the subjects from the earlier study. The information obtained in those reviews was used to address the following continuity of care issues: 1. The psychiatric medication regime recommended in the state hospital discharge plan and the medications obtained during six months post discharge (as reflected in Medicaid pharmacy claims data) were examined to determine the extent to which there was continuity of care between recommended and actual use of "atypical" psychotropic medications. 2. Community service data (as reflected in service/event data in the Department of Children and Families Integrated Data System database) were examined to describe the pattern of services received in the community and to determine whether persons attended community services that matched levels of care needs identified in the state hospital discharge plans. A few of the major findings of the study are presented below: 1. A large number of the patients discharged from the four state mental hospitals require treatment for substance abuse and serious physical health disorders in addition to their mental health needs. 2. All patient groups use "Atypical" psychotropic medications frequently in state hospitals, but at a slightly higher frequency with patients who have been enrolled in Medicaid compared to NonMedicaid patients. 3. If a patient had any trial of "atypicals" in the hospital, there is a 90% chance for Medicaid patients and a 100% chance for Non-Medicaid patients of having the Discharge Plan recommend continuation of "atypicals" after discharge. 4. Medicaid patients whose discharge plans included recommendation for "atypicals" were over four times more likely to receive "atypicals" in the community than if the discharge plans recommended only "traditional" psychotropic medications. 5. 62% of the patients with Medicaid pharmacy claims for "atypicals" and 66% of the patients with Medicaid pharmacy claims for "traditional" psychotropic medications during the six-month post discharge follow-up also had Medicaid pharmacy claims for drugs used to treat serious physical health disorders 6. Assuming that the six recommended Nursing Home placements happened, a total of 43% of the Medicaid Enrolled and 63% of the Non-Medicaid "supervised housing" recommendations were accomplished in the community. 7. For both Medicaid and Non-Medicaid groups, patients recommended for Supervised Housing and case management services or Other Housing and case management services were most likely to show up in the six-month post discharge IDS database as having actually lived in "Supervised Housing". 8. Medicaid patients recommended for unsupervised living situations with a recommendation for case management services were the most likely to receive community based crisis services within the first three months post discharge. 9. Patients recommended for case management who actually received case management services are also most likely to be readmitted to the state mental hospital during the six month followup. 10. Presence of co-morbid physical health conditions may account for greater mortality and morbidity in severely mentally ill patients discharged from state mental hospitals than suicide.
Scholar Commons Citation
Ward, John C.; Boaz, Timothy L.; Vossberg, Keith; and Teague, Gregory B., "State mental hospital continuity of care study 2: Comparison of state mental hospital discharge plans with post discharge housing placements, participation in community behavioral health services, and use of psychotropic medication" (2001). Mental Health Law & Policy Faculty Publications. 508.