Planning Patient-Centered Health Homes for Medicaid Psychiatric Patients at Greatest Risk for Intensive Service Use

This study identified characteristics of Medicaid psychiatric patients at risk of hospitalizations and emergency department (ED) visits to identify their service delivery needs. A total of 4,866 psychiatrists were randomly selected from the AMA Physician Masterfile; 62 % responded, 32 % met eligibil...

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Bibliographic Details
Published in:Community mental health journal 2015-07, Vol.51 (5), p.513-522
Main Authors: West, Joyce C., Rae, Donald S., Mojtabai, Ramin, Duffy, Farifteh F., Kuramoto, Janet, Moscicki, Eve, Narrow, William E.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Community and Environmental Psychology
Community Mental Health Services
Cost control
Critical care
Databases, Factual
Drug use
Emergency medical care
Emergency Service, Hospital - utilization
Female
Halfway Houses
Health care
Health care policy
Health risk assessment
Hospitalization
Hospitalization - statistics & numerical data
Humans
Intervention
Male
Medicaid
Medicine
Medicine & Public Health
Mental disorders
Mental Disorders - epidemiology
Mental Disorders - therapy
Mental health
Mental health care
Middle Aged
Multivariate Analysis
Original Paper
Patient-Centered Care
Patients
Psychiatric Department, Hospital - statistics & numerical data
Psychiatric Department, Hospital - utilization
Psychiatrists
Psychiatry
Psychosis
Risk Factors
Schizophrenia
Sociodemographics
Substance use disorder
United States - epidemiology
Young Adult
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Summary:This study identified characteristics of Medicaid psychiatric patients at risk of hospitalizations and emergency department (ED) visits to identify their service delivery needs. A total of 4,866 psychiatrists were randomly selected from the AMA Physician Masterfile; 62 % responded, 32 % met eligibility criteria and reported on 1,625 Medicaid patients. Patients with schizophrenia, substance use disorders, suicidal and violent ideation/behavior, and psychotic, substance use, or manic symptoms were at high risk for intensive service use, along with homeless and incarcerated patients. Patients with schizophrenia or psychotic symptoms represented 37 % of patients, but used 73 % of all hospital days and 61 % of all ED visits. Patients with substance use problems comprised 21 % of patients, but used nearly half of all ED visits. Our findings highlight opportunities to enhance treatments and interventions, and inform the development of patient-centered health homes to address the needs of patients at high risk for intensive service use.
ISSN:0010-3853
1573-2789
DOI:10.1007/s10597-015-9834-z