Evaluation of a Crisis/Transition Intervention to Prevent Psychiatric Hospital Admissions and Readmissions Among Medicaid-Eligible Individuals with Serious Mental Illness

Background and Purpose: Compared to the general population, individuals with serious mental illness (SMI) are more likely to have medical conditions that remain undiagnosed and untreated. As a result, individuals with SMI have higher morbidity and mortality due to a variety of comorbid physical conditions. Even when linked to the health care system, individuals with SMI are less likely to receive recommended treatment and have worse outcomes when treated. These inequities result in higher utilization of emergency department services and higher rates of inpatient admissions in the SMI population compared to the general population. Moreover, about 13% of psychiatric patients are readmitted within a short time of discharge due in part to poor access to community based mental health care, medication adherence, and the lack of aftercare. This study evaluated whether a short-term crisis/transition intervention for Medicaid-eligible individuals with SMI prevented unnecessary psychiatric hospital admissions and readmissions.

Methods: A sample of 37 consumers was obtained by simple random sample from 59 consumers who had completed the intervention and had six months of follow-up data. Consumers’ health service utilization data was retrieved from the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES), which is managed by the New York State Office of Mental Health. Utilization was calculated for the 1 year and 3-month periods prior to the intervention as well as the 3-month period following the intervention. Descriptive statistics were calculated for all measures, and utilization pre and post intervention was compared using the t-test.

Results: About 76% of consumers identified as male, the majority were Caucasian (68%), and 19% were non-Hispanic Black. Eight percent of consumers were Hispanic. In the 3-month follow-up period, there were on average 11.1 less (SD=17.9) psychiatric inpatient days per consumer than the 3-month period prior to the intervention (from 12.8 to 1.7 days per consumer). This difference was statistically significant (p=0.001). In the 3-month period prior to the intervention, 19 out of 37 consumers (51%) had a psychiatric inpatient stay. During the 3-month follow-up, 4 of these 19 consumers (21%) had a psychiatric readmission. The same data was compared for 19 high utilizers (consumers with < 10 behavioral inpatient days in the three months prior to the intervention).  High utilizers had an average of 22.9 less (SD=16.9) psychiatric inpatient days (from 12.8 to 1.7 days per consumer) when comparing the 3-month pre and the 3-month follow-up periods. This difference was statistically significant (p<0.01).

Conclusions and Implications: This research indicates that there was a statistically significant reduction in the average number of psychiatric inpatient days per consumer following the crisis/transition intervention. This effect seemed to be amplified for high utilizers.

Overall, this study supports research that intensive community-based crisis/transition interventions are an effective way to prevent unnecessary inpatient utilization in the SMI population.  However, additional research is needed to understand long-term trends in utilization in this population. This study is unique in its use of PSYCKES data for measuring service utilization, since the data is mainly used for quality improvement and clinical decision-making.