Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care

Area of Science:

• Psychiatry
• Health Services Research
• Public Health

Background:

• Effective discharge planning is crucial for continuity of care in psychiatric treatment.
• Gaps in discharge planning can lead to readmissions and poorer patient outcomes.
• Understanding factors influencing discharge planning is essential for improving mental healthcare systems.

Purpose of the Study:

• To examine patient, hospital, and service system factors associated with discharge planning for psychiatric inpatients.
• To identify specific patient characteristics that predict the failure to schedule follow-up outpatient appointments.

Main Methods:

• Retrospective cohort analysis of 18,185 New York State Medicaid patients (<65 years) treated in psychiatric units (2012-2013).
• Linked claims data with managed care, hospital, and state administrative databases.
• Assessed rates and adjusted odds ratios for scheduled follow-up outpatient appointments.

Main Results:

• Outpatient appointments were scheduled for 79.8% of discharges.
• Homelessness, co-occurring substance use disorders, high medical comorbidity, and lack of prior outpatient engagement were associated with not scheduling appointments.
• Patient characteristics showed stronger associations with discharge planning failures than hospital or service system factors.

Conclusions:

• Patient-level factors are more influential than hospital or service system factors in determining the provision of psychiatric discharge planning.
• Targeting interventions for high-risk patient groups (e.g., homeless, those with SUDs) is critical for improving discharge planning.
• Further research should explore system-level interventions to address disparities in care transitions.