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Efficacy of the Home-Based Mental Health Evaluation (HOME) Program for Engaging Patients in Care After Hospitalization.

Matarazzo BB, Forster JE, Hostetter TA, Billera M, Adler G, Ganzini LK, Oslin DW, Brenner LA. Efficacy of the Home-Based Mental Health Evaluation (HOME) Program for Engaging Patients in Care After Hospitalization. Psychiatric services (Washington, D.C.). 2019 Dec 1; 70(12):1094-1100.

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OBJECTIVE: The risk of suicide is elevated in the days and weeks after discharge from a psychiatric hospitalization, and lack of treatment engagement posthospitalization is also associated with suicide. The authors sought to determine whether the Home-Based Mental Health Evaluation [HOME] Program is efficacious in helping patients engage in care after psychiatric hospitalization. METHODS: This study was a nonrandomized, controlled, two-arm (HOME Program versus enhanced care as usual [E-CARE]) trial that took place at four Department of Veterans Affairs medical centers. Participants (N = 302) were patients admitted to a psychiatric inpatient unit. The HOME Program consists of phone- and home-based contacts that include suicide risk assessment, safety planning, and problem-solving around barriers to care. The primary outcome was treatment engagement, as documented in the electronic medical record. RESULTS: Veterans in the HOME Program group were 1.33 (95% confidence interval [CI] = 1.29-1.37) times more likely to engage in treatment, compared with veterans in the E-CARE group (p < 0.001). HOME Program participants were estimated to have attended 55% more individual appointments (95% CI = 12%-113%, p = 0.02), compared with those in the E-CARE group. The adjusted difference in median time to treatment engagement was 15 days (95% CI = 3.5-27.0) such that HOME Program participants engaged in treatment more quickly than participants at the E-CARE sites. CONCLUSIONS: Findings suggest that participation in the HOME Program can help individuals at high risk of suicide engage in care after psychiatric hospitalization.

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