Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression.

Kim HM, Pfeiffer P, Ganoczy D, Valenstein M. Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression. Psychiatric services (Washington, D.C.). 2011 Nov 1; 62(11):1346-52.

Related HSR&D Project(s)

• CDA 10-036 – Improving Depression Care Following Psychiatric Hospitalization

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Abstract:

OBJECTIVE: This study assessed whether increased frequency of clinical monitoring during the high-risk period of 12 weeks after discharge from a psychiatric hospitalization reduced subsequent rehospitalization in a national cohort of Veterans Health Administration patients receiving depression treatment between 1999 and 2004. METHODS: A case-control design was used. Patients who had at least two inpatient psychiatric hospitalizations were identified (case group, N = 17,852) and then individually matched with up to two patients who also had been discharged from psychiatric inpatient settings but were not rehospitalized for the number of days between the case-group patient's discharge and subsequent rehospitalization (N = 35,511). RESULTS: Covariate-adjusted relative risk (RR) did not show an association between increased monitoring and subsequent psychiatric hospitalization, but there was a significant negative interaction between monitoring and a comorbid substance use disorder diagnosis (p < .001). Increased monitoring was positively associated with rehospitalization of patients without a substance use disorder, whereas increased monitoring was not associated with increased risk of rehospitalization of those with a comorbid substance use disorder. The RR of rehospitalization associated with a weekly monitoring visit (12 visits per 84 days) versus no monitoring visit was 1.14 for patients without a substance use disorder, whereas the RR was reduced to .94 for patients with a substance use disorder. CONCLUSIONS: Increased outpatient monitoring during the high-risk period after discharge appears to have a modest protective effect on rehospitalization among depressed patients with a comorbid substance use disorder.