IMPACT OF INITIAL HOSPITALIZATION ON 3-YEAR OUTCOME IN PATIENTS WITH FIRST EPISODE PSYCHOSIS IN HONG KONG

Abstract

used to generate unbiased and efficient estimates, as well as proper standard errors. This modeling takes into account (a) the influence of different sample sizes across counties and (b) the dependence among individual outcomes clustered within the same county. Results: HLM showed both significant individual and contextual effects. Race (i.e. African American), homelessness, and comorbidity of a substance abuse significantly decreased the odds of conforming to standards of continuity of care. Co-morbidity of substance abuse provided the most substantial decrease in rates of conformance. There was very little consistency in odds of conformance rates for contextual level variables. Conformance to standards of quality continuity of care decreased if the community had higher rates of poverty, had fewer community mental health centers, and was classified as rural. Discussion: The overall findings show that basic standards of quality continuity of care are not being met for some adults with schizophrenia in parts of the USA. The results highlight substantial disparities in basic standards of quality continuity of care. Conformance rates are significantly lower for African Americans and the homeless. Particularly striking were the results for those with a cooccurring substance abuse disorder as they had the lowest conformance rate of any individual based factor. Contextual factors significantly associated with lower conformance rates were number of available mental health centers, level of poverty, and whether the community is rural. Such disparities leave certain individuals and communities vulnerable to a host of negative consumer outcomes. The results demonstrate a clear need for quality of care monitoring particularly for specific groups and communities. The results can serve as guidance for future research in disparities in quality of care.