Assessing the impact of an innovate behavioral health clinic: a retrospective cohort study

Patients experiencing a mental health crisis often present to the emergency department and are admitted to an inpatient facility for treatment. This can cause incontinuity in care, increased costs, and may worsen clinical outcomes compared to treatment in the outpatient setting. An innovative behavioral health clinic (BHC) was established to provide a number of critical mental health services such as individual therapy, crisis stabilization, partial hospitalization, substance abuse intensive outpatient services, specialized intensive adult group therapy, medication management (including long-acting injectable antipsychotic administration), and a peer living room. The primary outcome of this study was to assess the impact of the BHC on length of stay (LOS), psychiatric rehospitalization rate, and all-cause emergency department (ED) visits. The secondary outcome was to analyze the interaction of various patient characteristics with the primary outcome.

The study site was a community-based health system in the southeastern United States. A retrospective review of medical records was performed for adult patients with a psychiatric hospitalization in 2019 (pre-BHC) and 2022 (post-BHC). Primary outcomes were analyzed using Chi-Square testing and Mann-Whitney U testing. Secondary outcomes were analyzed using Poisson and logistic regression modeling. This study was deemed exempt from review by the health system and university institutional review boards.

Following the establishment of the BHC, mean LOS was significantly longer (+ 1.26 days, p = 0.001) and there was a statistically significant reduction in 30-day (-10.3%, p < 0.001) and 1-year (-28.2%, p < 0.001) rehospitalization as well as 30-day (-8.3%, p = 0.004) and 1-year (-13.5%, p < 0.001) ED visit rate. A diagnosis of schizophrenia and prescription of a LAI were associated with a significant increase in LOS, while being uninsured was associated with a significant decrease. Male gender and a diagnosis of schizophrenia were associated with a significant increase in ED visits, while identifying as White or Caucasian, being uninsured or carrying private insurance, and prescription of a LAI were associated with a significant decrease.

The implementation of an innovative BHC positively impacted patient care outcomes in the study population. Patient characteristics were identified which independently interacted with these outcomes.