Upload
dorthy-shelton
View
220
Download
5
Tags:
Embed Size (px)
Citation preview
Strategies For Health Care Organizations to Improve Treatment Engagement, Monitor
Success, and Maximize Resources: Effectiveness of a Brief Care Management
Intervention for Reducing Psychiatric Hospital Readmissions
Carole Taylor, MSN, RN, Chief Clinical OfficerJenny Flanagan, MA, LPC, Clinical CoordinatorShari Hutchison, MS, Manager of Outcomes
© 2014 Community Care Behavioral Health Organization
About Community Care
• Behavioral health managed care company founded in 1996; part of UPMC and headquartered in Pittsburgh
• Federally tax exempt non-profit 501(c)(3)
• Major focus is publicly-funded behavioral health care services; currently doing business in PA and NY
• Licensed as a Risk-Assuming PPO in PA; NCQA- Accredited Quality and Disease Management Programs
• Serving over 750,000 individuals receiving Medical Assistance in 39 counties through a statewide network of over 1,800 providers
2© 2014 Community Care Behavioral
Health Organization
HealthChoices Regions Served
3© 2014 Community Care Behavioral
Health Organization
Southwest Region
Lehigh-Capital Region
Southeast Region
Northeast Region
North Central Region: County
North Central Region: State
North Central Region: County
North Central Region: County
North Central Region: County
Community Care Office
Pike
Erie
Crawford
Mercer
Venango
ButlerArmstrong
Indiana
Westmoreland
Allegheny
Greene
FayetteSomerset
CambriaBlair
Delaware
Clarion
Forest
Warren McKean Potter
CameronElk
Jefferson
Clearfield
Bedford
Centre
Clinton
Fulton Franklin
Adams
Cumberland
Perry
MifflinSnyder
Union
Lycoming
Tioga Bradford
ColumbiaMontour
Northumberland
Dauphin
York
Lancaster
Chester
Berks Lebanon
Schuylkill
Montgomery
Philadelphia
Juniata
Sullivan
HuntingdonBucks
LehighNorthampton
Carbon
Monroe
Pike
Luzerne
WyomingLackawanna
Susquehanna
Wayne
Lawrence
Beaver
Washington
Project Background
• In psychiatric settings, it has been recently estimated that 18-67% of patients with serious mental illness (SMI) do not receive treatment immediately following psychiatric hospitalization
• Continued engagement in care following psychiatric hospital discharge may prevent adverse outcomes, including re-hospitalization
• Consequently, there is a pressing need to test strategies that may reduce adverse outcomes by preventing treatment dropout during this transitional period
4© 2014 Community Care Behavioral Health Organization
Rationale
• Individuals with multiple admissions to psychiatric inpatient service within a year and/or longer lengths of stay during inpatient are at high risk for psychiatric readmission within 30 days
• Interventions and services targeting high-risk individuals are successful in decreasing readmission rate
• In 2011-2012, two interventions aimed at decreasing hospital readmission in high-risk populations were initiated– High-Risk Care Management Focus on
Multiple Readmissions– Critical Time Intervention in Acute Service
Coordination
5© 2014 Community Care Behavioral Health Organization
High Risk Care Management
• Consists of eight care managers (CMs) who have LSW, LCSW, LPC, or RN licenses
• CMs complete telephonic continued stay and discharge reviews for acute levels of care and specialized services
• CMs attend multiple community meetings (disposition, treatment team & interagency) to assist with discharge planning
• CMs receive referral requests for higher level community support services to screen for appropriateness (CTT, Mobile Meds & ECSC)
6© 2014 Community Care Behavioral Health Organization
Target Population
• Adult members with a 30-day inpatient mental health readmission to the two highest volume facilities in Allegheny County
• Alternating weeks for each facility to differentiate between those members who received a high risk care manager intervention and those who did not
• Pilot project with two high-volume facilities occurred from April 2011 – May 2012
7© 2014 Community Care Behavioral Health Organization
Focus of Interviews
• Barriers related to aftercare linkage and follow up
• Awareness of and utilization of crisis plans
• Identification of resources, services, and supports needed to assist the member with remaining in the community– Members frequently reported lack of
housing, primary supports, and drug and alcohol use as major contributing factors
8© 2014 Community Care Behavioral Health Organization
Care Management Interventions
• Follow up occurred with the inpatient treatment team to ensure: – Linkage to aftercare providers– Linkage to higher level of community
supports such as:• Acute Service Coordination• Mobile Medications• Community Treatment Team• Diversion and Acute Stabilization Units• Drug and Alcohol Rehabilitation
Programs
9© 2014 Community Care Behavioral Health Organization
Outcomes of Interviews
• During the identified timeframe, 80 adult members received an interview and 80 did not
• Demographics of individuals receiving the interview :– 41% female– 59% white– 41% black/African American– Age ranged from 18-64 years – Average age of 36 years
10© 2014 Community Care Behavioral Health Organization
Outcomes of Interviews
• The 30-day readmission rate for individuals receiving the interview was 39% lower than the readmission rate for individuals in the non-intervention comparison group – 23.8% versus 38.8%, respectively
• Controlling for member characteristics and prior behavioral health service utilization, individuals in the non-intervention group were significantly more likely to be readmitted than those in the intervention group – aOR 2.38, 95% CI 1.03-5.48, p=.04
11© 2014 Community Care Behavioral Health Organization
Critical Time Intervention in ASC
• Acute Service Coordination (ASC) – Higher intensity service coordination;
contact before inpatient discharge• Imbed Critical Time Intervention (CTI) to
address transition in care • CMs receive referral requests for higher
level community support services to screen for appropriateness (CTT, Mobile Meds & ECSC)
12© 2014 Community Care Behavioral Health Organization
Target Population
• Adult members with a 30-day inpatient mental health readmission and referred to ASC
• Evaluation of outcomes for intervention and historical comparison cohorts
• CTI training and implementation 2011; historical comparison cohort of ASC 2010
13© 2014 Community Care Behavioral Health Organization
Results: ASC with CTI
• During the identified timeframe, 160 adult members received ASC with CTI and 226 received ASC alone
• Demographics of individuals receiving the interview :– 51% female– 56% white– 42% black/African American– Average age of 39 years
14© 2014 Community Care Behavioral Health Organization
Impact of ASC with CTI on readmission• The 30-day readmission rate for individuals
receiving ASC with CTI was significantly lower than the readmission rate for individuals in the comparison cohort– 26.3% versus 46.9%, respectively
• Controlling for member characteristics and prior behavioral health service utilization, individuals in the non-intervention group were significantly more likely to be readmitted than those in the intervention group – aOR 2.92, 95% CI 1.77-4.80, p<.001
15© 2014 Community Care Behavioral Health Organization
Contact
Carole [email protected]
Jenny [email protected]
Shari [email protected]
16
© 2014 Community Care Behavioral Health Organization