Variation of Follow-Up Rate After Psychiatric Hospitalization of Medicare Beneficiaries by Hospital Characteristics and Social Determinants of Health

Abstract

Early follow-up after inpatient psychiatric hospitalization is a key part of the care transition process and has been found to reduce the risk of readmission and emergency department utilization. Our objective was to determine the extent to which hospital performance on measures of 7- and 30-day mental health follow-up after hospitalization for Medicare beneficiaries varies by hospital characteristics and hospital neighborhood socioeconomic characteristics. We linked 2015 hospital-level follow-up rates from the Centers for Medicare and Medicaid Services' Hospital Compare website to hospital characteristics obtained from the American Hospital Association Annual Survey and characteristics of the community within a 5-mile radius of the hospital obtained from the American Community Survey. Our population included 1,275 inpatient psychiatric facilities in 2015 in the United States. State fixed effects multivariate linear regression was used. Hospital 30-day follow-up rates ranged from 16.00% to 95.00%, with an average of 55.80%. After controlling for hospital- and community-level factors, and applying state-level fixed effects, we found that psychiatric specialty hospitals, public hospitals, and minority-serving hospitals were associated with lower rates of mental health follow-up. Hospitals have considerable opportunity to improve the quality of their transitional care processes and increase the percentage of Medicare patients receiving timely mental health follow-up after discharge. Policymakers should consider strengthening the incentives for hospital performance on these quality measures while working to improve the behavioral health infrastructure of minority communities.