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A Study of the Relationship between Individual Patient Factors, Utilization, and Outcomes for Veterans Receiving Mental Health Services

Fasoli DR, Glickman ME, Seal P, Eisen SV. A Study of the Relationship between Individual Patient Factors, Utilization, and Outcomes for Veterans Receiving Mental Health Services. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD.

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Objectives: Research findings examining the effect of mental health service utilization on mental health outcomes are mixed. Moreover, service intensity per veteran is decreasing, while demand for VA mental health services is increasing. The purpose of this study was to examine the relationship between mental health service utilization and individual patient factors on mental health outcomes, using Andersen's Behavioral Model of Health Service Utilization. Methods: This was an observational prospective study of veterans receiving inpatient or outpatient mental health services at one of four VA programs in Massachusetts from 2004 to 2006. Follow-up clinician-rated assessments [Global Assessment Functioning Scale (GAF)] were completed on 546 veterans, including 202 inpatients and 344 outpatients. Three self-reported surveys (BASIS-R, BSI, and MCS of SF-36) also were completed. Assessments occurred at baseline (T1) and at follow-up, three months post-enrollment (T2). Hierarchical linear and logistic regression analyses were conducted to explore the simultaneous effect of predisposing characteristics (e.g., race, education, age, gender, and marital status), clinical need (e.g., level of care at enrollment, baseline mental health, physical functioning, number of comorbid conditions, disability, and pre-enrollment utilization), enabling resources (e.g., social support, employment status, financial assistance, stable housing, and ease of access to treatment), and utilization (e.g., outpatient visits, residential treatment, and inpatient hospitalization) on mental health outcomes. Results: Aspects of clinical need and lack of enabling resources significantly predicted outpatient, residential and inpatient utilization. Specifically, more comorbidities, pre-enrollment utilization, and unemployment predicted greater outpatient utilization and residential treatment at T2. More comorbidities, pre-enrollment utilization, and homelessness predicted inpatient hospitalization at T2. Regarding outcomes, clinical need (better baseline mental health), and utilization (residential treatment, lack of inpatient hospitalization, and more outpatient visits) were associated with better outcomes. No predisposing characteristics or enabling resources were significant predictors of mental health outcomes. Implications: Mental health service utilization has an impact on outcomes, over and above the effect of clinical need. Furthermore, employment and stable housing have an impact on increasing utilization of mental health services. Impacts: This research suggests policymakers should direct resources towards efforts to improve appropriate utilization and the actionable factors of employment and housing to improve mental health outcomes for veterans.

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