Strategies for Care System Transitions in Mental Health: A Systematic Review

Apaydin EA, Delavale V, Fu N, Larkin J, Chough I, Motala A, Hempel S. Strategies for Care System Transitions in Mental Health: A Systematic Review. Santa Monica, CA: RAND Corporation; 2022 Jan 1.

Background Care transitions are a common feature of health care, but most occur within a single health care system. However, patients can also face transitions between systems when they experience life events such as a new job, a change in insurance providers, or a move between locations. These transitions can be especially complicated when patients leave an integrated health care system such as the Military Health System (MHS) and are required to manage their own care until they enter a new system. Navigating these transitions can be especially important for patients who need regular care, such as those with mental health conditions. The objective of this systematic review and meta-analysis is to summarize the evidence on interventions that are intended to improve health care system transitions for patients with mental health conditions. This review examined the following key question (KQ) and subquestions: - KQ1. What are the effects of mental health care transition programs? - KQ1a. What are the effects of mental health care transition programs for transitions from military to veteran health care systems? - KQ1b. Do the effects vary by population? - KQ1c. Do the effects vary by intervention type? - KQ1d. Do the effects vary by country? Methods We searched research databases (PubMed, PsycINFO, and the Web of Science), databases and registries of systematic reviews (Cochrane Database of Systematic Reviews [CDSR], Campbell Collaboration, International Prospective Register of Systematic Reviews [PROSPERO], Open Science Framework), and the Defense Technical Information Center (DTIC) database from inception to April 2020 for English-language evaluations of interventions to improve health care transitions for patients with mental health conditions. Existing systematic reviews were reference%2mined for additional studies. The review was registered in PROSPERO (CRD42020187360). Citations from these searches were independently screened by two reviewers using predetermined eligibility criteria. Both reviewers independently abstracted categorical data from studies that met inclusion eligibility criteria. One reviewer abstracted data and assessed risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool for included studies. These responses were independently checked by the topic lead. Outcomes included measures of health, health care, patient experience, and unintended consequences. ix Results across studies were summarized using Hartung-Knapp corrected random effect meta*nalyses when data allowed. All results were described in a narrative review. Meta-regressions were performed by preplanned subgroup analyses, which examined differential intervention effects by population, intervention subtype, and study country. Quality of evidence for each outcome in meta-analyses was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results We identified interventions targeting health care transitions for active duty service members entering civilian life, children entering adulthood, and recently released prisoners. Quality of evidence was low or very low for most main and subgroup analyses.