Association between mental health aftercare telephone calls and post-discharge mental health visits for patients on a CL service
Abstract
Background:
Mental health (MH) engagement after discharge from hospitalization is considered an important outcome measure for MH patients. The VA San Diego Healthcare System (VASDHS) has implemented mental health aftercare calls (MHACs) for psychiatric patients discharged from the emergency department, the psychiatric unit, and the medical floors. While every patient discharged from the medical floors receives a primary care aftercare call, only a subset of patients admitted to the medical floors receive MHACs. These patients are identified by a mental health admission diagnosis. In this quality improvement study and innovation, we assess the association between MHACs and the probability of post-discharge MH visits in patients discharged from the medical floors who were seen by the inpatient consult-liaison (CL) psychiatry service.
Description of the Project:
This project is a retrospective review based on encounter codes of an electronic health record for patients admitted to the medical floors at the VASDHS between January-December 2022 who were also seen by the inpatient CL service. The patients who were seen by the CL service were grouped into those who received MHACs and those who did not. Cox regression was used to evaluate the relationship between MHAC and post-discharge likelihood of mental health visit.
Lessons Learned/Expected Outcomes:
386 patients seen by the CL service were identified for analysis. 362 patients did not receive a call and 24 patients did. After controlling for gender, age, and the number of CL encounters, we found that 51% of patients without a call had a MH visit within 6 months post-discharge, compared with 75% in those patients who were called (HR = 1.3, p>0.05). We found that 33% of patients without a call had a MH visit in the first month post-discharge, compared with 54% in those patients who were called. While these findings were not statistically significant, likely due to low power, this may indicate an increased probability of a MH visit with aftercare calls.
Recommendations/Next Steps:
Our findings support further analysis and utilization of MHACs for psychiatric patients discharged from the medical floors. The availability of trained mental health nursing staff to conduct MHACs is currently a highly limited resource. Our plan is to develop a systematic protocol for the inpatient CL service to identify patients who they’ve seen who may benefit from a MHAC. This protocol would be used in conjunction with the existing systems-based metrics used to identify patients for MHACs and allow for conscientious utilization of MHACs in post-discharge engagement for psychiatric patients admitted to the medical floors. To identify patients most likely to benefit from MHACs, this protocol should account for patient characteristics such as age, number of recent admissions, MH diagnoses, and/or treatment complexity. Further analysis to assess the efficacy and conscientious use of this valuable staff resource can then be repeated after protocol implementation.