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Administration and Policy in Mental Health and Mental Health Services Research
Published in: Administration and Policy in Mental Health and Mental Health Services Research 5/2014

01-09-2014 | Original Article

Individual and Contextual-Level Factors Associated with Continuity of Care for Adults with Schizophrenia

Authors: Cynthia A. Fontanella, Joseph Guada, Gary Phillips, Lorin Ranbom, John C. Fortney

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 5/2014

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Abstract

This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18–64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.
Literature
Adair, C. E., McDougall, G. M., Beckie, A., Joyce, A., Mitton, C., Wild, C. T., et al. (2003). History and measurement of continuity of care in mental health services and evidence of its role in outcomes. Psychiatric Services, 54(10), 1351–1356.PubMedCrossRef
Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220.PubMedCentralPubMed
American Psychiatric Association. (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Journal of Psychiatry, 160(Nov suppl), 1–60.
American Psychiatric Association (APA). (2004a). Practice guideline for the treatment of patients with schizophrenia (2nd ed.). Arlington, VA: American Psychiatric Association.
American Psychiatric Association (APA). (2004b). American Psychiatric Association practice guidelines for the treatment of psychiatric disorders: Compendium 2004. Arlington, VA: American Psychiatric Association.
Anderson, G., & Knickman, J. R. (2001). Changing the chronic care system to meet people’s needs. Health Affairs, 20(6), 146–160.PubMedCrossRef
Bachrach, L. L. (1981). Continuity of care for chronic mental patients: a conceptual analysis. American Journal of Psychiatry, 138(11), 1449–1456.PubMed
Bazzoli, G. J., Kang, R., Hasnain-Wynia, R., & Lindrooth, R. C. (2005). An update on safety-net hospitals: Coping with the late 1990s and early 2000s. Health Affairs, 24(4), 1047–1056.PubMedCrossRef
Brekke, J. S., & Test, M. A. (1992). A model for measuring the implementation of community support programs: results from three sites. Community Mental Health Journal, 28(3), 227–247.PubMedCrossRef
Buckley, P. F., Miller, B. J., Lehrer, D. S., & Castle, D. J. (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin, 35(2), 383–402.PubMedCentralPubMedCrossRef
Burns, T., Catty, J., White, S., Clement, S., Ellis, G., Jones, I. R., et al. (2009). Continuity of care in mental health: Understanding and measuring a complex phenomenon. Psychological Medicine, 39(2), 313–323.PubMedCrossRef
Busch, A. B., Lehman, A. F., Goldman, H., & Frank, R. G. (2009). Changes over time and disparities in schizophrenia treatment quality. Medical Care, 47(2), 199–207.PubMedCentralPubMedCrossRef
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.PubMedCrossRef
Chow, J. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792–797.PubMedCentralPubMedCrossRef
Crawford, M. J., de Jonge, E., Freeman, G. K., & Weaver, T. (2004). Providing continuity of care for people with severe mental illness: A narrative review. Social Psychiatry and Psychiatric Epidemiology, 39(4), 265–272.PubMedCrossRef
Cuffel, B. J., Shumway, M., Chouljian, T. L., & MacDonald, T. (1994). A longitudinal study of substance use and community violence in schizophrenia. Journal of Nervous and Mental Disease, 182(12), 704–708.PubMedCrossRef
Cunningham, P. J., Bazzoli, G. J., & Katz, A. (2008). Caught in the competitive crossfire: Safety-net providers balance margin and mission in a profit-driven health care market. Health Affairs, 27(5), 374–382.CrossRef
Davidson, P. L., Andersen, R. M., Wyn, R., & Brown, E. R. (2004). A framework for evaluating safety-net and other community-level factors on access for low-income populations. Inquiry, 41(1), 21–38.PubMed
Dickey, B., & Azeni, H. (1996). Persons with dual diagnoses of substance abuse and major mental illness: Their excess costs of psychiatric care. American Journal of Public Health, 86(7), 973–977.PubMedCentralPubMedCrossRef
Dickey, B., Normand, S. L., Hermann, R. C., Eisen, S. V., Cortes, D. E., Cleary, P. D., et al. (2003). Guideline recommendations for treatment of schizophrenia: The impact of managed care. Archives of General Psychiatry, 60(4), 340–348.PubMedCrossRef
Dixon, L., Goldberg, R., Iannone, V., Lucksted, A., Borown, C., Kreyenbuhl, J., et al. (2009). Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatric Service, 60(4), 451–458.CrossRef
Donabedian, A. (1980). The definition of quality and approaches to its assessment: Explorations in quality assessment and monitoring. Ann Arbor, MI: Health Administration Press.
Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA, the Journal of the American Medical Association, 260(12), 1743–1748.CrossRef
Drake, R., & Mueser, K. T. (2002). Co-occurring alcohol use disorder and schizophrenia. Alcohol Research & Health, 26(2), 99–102.
Drake, R., Osher, F., Noordsy, D., Hurlbut, S., Teague, G., & Beaudett, M. (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin, 16(1), 57–67.PubMedCrossRef
Fischer, E., McCarthy, J., Ignacio, R., Blow, F., Barry, K., Hudson, T., et al. (2008). Longitudinal patterns of health system retention among veterans with schizophrenia or bipolar disorder. Community Mental Health Journal, 44(5), 321–330.PubMedCrossRef
Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, E. L. (2003). The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Annals of Internal Medicine, 138(4), 273–287.PubMedCrossRef
Fortney, J., Sullivan, G., Williams, K., Jackson, C., Morton, S. C., & Koegel, P. (2003). Measuring continuity of care for clients of public mental health systems. Health Services Research, 38(4), 1157–1175.PubMedCentralPubMedCrossRef
Fortney, J. C., Xu, S., & Dong, F. (2009). Community-level correlates of hospitalizations for persons with schizophrenia. Psychiatric Services, 60(6), 772–778.PubMedCrossRef
Fuchs, V. R. (2004). Perspective: More variation in use of care, more flat-of-the-curve medicine. Health Affairs, Suppl Variation, 104–107.
Goldman, H., Ganju, V., Drake, R. E., Gorman, P., Hogan, M., Hyde, M., et al. (2001). Policy implications for implementing evidence-based practices. Psychiatric Services, 52(12), 1591–1597.PubMedCrossRef
Greenberg, G. A., Rosenheck, R. A., & Fontana, A. (2003). Continuity of care and clinical effectiveness: treatment of posttraumatic stress disorder in the Department of Veterans Affairs. Journal of Behavioral Health Services & Research, 30(2), 202–214.CrossRef
Gresenz, C. R., Stockdale, S. E., & Wells, K. B. (2000). Community effects on access to behavioral health care. Health Services Research, 35(1), 293–306.PubMedCentralPubMed
Haywood, T. W., Kravitz, H. M., Grossman, L. S., Cavanaugh, J. L, Jr, Davis, J. M., & Lewis, D. A. (1995). Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. American Journal of Psychiatry, 152(6), 856–861.PubMed
Hellerstein, D. J., Rosenthal, R. N., & Miner, C. R. (1995). A prospective study of integrated substance-abusing schizophrenic patients. American Journal on Addictions, 4(1), 33–42.CrossRef
Hendryx, M. S., & Rohland, B. M. (1994). A small area analysis of psychiatric hospitalizations to general hospitals: Effects of community mental health centers. General Hospital Psychiatry, 16(5), 313–318.PubMedCrossRef
Hendryx, M. S., Urdaneta, M. E., & Borders, T. (1995). The relationship between supply and hospitalization rates for mental illness and substance use disorders. Journal of Mental Health Administration, 22(2), 167–176.PubMedCrossRef
Herman, S. E., BootsMiller, B., Jordan, L., Mowbray, C. T., Brown, W. G., Deiz, N., et al. (1987). Immediate outcomes of substance abuse treatment within a state psychiatric hospital. Journal of Mental Health Administration, 24(2), 126–138.CrossRef
Hermann, R. C., Chan, J. A., Provost, S. E., & Chiu, W. T. (2006). Statistical benchmarks for process measures of quality of care for mental and substance use disorders. Psychiatric Services, 57(10), 1461–1467.PubMedCrossRef
Hermann, R. C., Finnerty, M., Provost, S., Palmer, R. H., Chan, J., Lagodmos, G., et al. (2002). Process measures for the assessment and improvement of quality of care for schizophrenia. Schizophrenia Bulletin, 28(1), 95–104.PubMedCrossRef
Hermann, R. C., & Palmer, R. H. (2002). Common ground: A framework for selecting core quality measures for mental health and substance abuse care. Psychiatric Services, 53(3), 281–287.PubMedCrossRef
Institute of Medicine (IOM) (U.S.). (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.
Institute of Medicine (IOM) (U.S.). (2003). A shared destiny: Community effects of uninsurance. Washington, DC: National Academies Press.
Institute of Medicine (IOM) (U.S.). (2006). Improving the quality of health care for mental health and substance abuse conditions. Washington, DC: National Academies Press.
Institute of Medicine (U.S.). (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.
Johnson, S., Prosser, D., Bindman, J., & Szmukler, G. (1997). Continuity of care for the severely mentally ill: Concepts and measures. Social Psychiatry and Psychiatric Epidemiology, 32(3), 137–142.PubMed
Joyce, A. S., Wild, T. C., Adair, C. E., McDougall, G. M., Gordon, A., Costigan, N., et al. (2004). Continuity of care in mental health services: Toward clarifying the construct. Canadian Journal of Psychiatry, 49(8), 539–550.
Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, J. R., Laska, E. M., Leaf, P. J., et al. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36(6), 987–1007.PubMedCentralPubMed
Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2009). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 35(4), 696–703.PubMedCentralPubMedCrossRef
Kuno, E., & Rothbard, A. B. (2002). Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. The American Journal of Psychiatry, 159(4), 567–572.PubMedCrossRef
Lambert, D., & Agger, M. (1995). Access of rural Medicaid beneficiaries to mental health services. Health Care Financing Review, 17(1), 133–145.PubMed
Lambert, D., Agger, M., & Hartley, D. (1999). Service use of rural and urban Medicaid beneficiaries suffering from depression: The role of supply. Journal of Rural Health, 15(3), 344–355.PubMedCrossRef
Lehman, A. F., & Steinwachs, D. M. (1998). Patterns of usual care for schizophrenia: Initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophrenia Bulletin, 24(1), 11–20.PubMedCrossRef
Litaker, D., & Love, T. E. (2005). Health care resource allocation and individuals’ health care needs: Examining the degree of fit. Health Policy, 73(2), 183–193.PubMedCrossRef
Mayer, M., Slifkin, R., & Skinner, A. C. (2005). The effects of rural residence and other social vulnerabilities on subjective measures of unmet need. Medical Care Research and Review, 62(5), 617–628.PubMedCrossRef
McGlynn, E. A., Norquist, G. S., Wells, K. B., Sullivan, G., & Liberman, R. P. (1988). Quality-of-care research in mental health: Responding to the challenge. Inquiry, 25(1), 157–170.PubMed
Mojtabai, R., Fochtmann, L., Kotov, R., Chang, S., Craig, T. J., & Bromet, E. (2010). Patterns of mental health service use and unmet needs for care in individuals with schizophrenia in the US. US Psychiatry, 3, 53–58.
Mojtabai, R., Malaspina, D., & Susser, E. (2003). The concept of population prevention: Application to schizophrenia. Schizophrenia Bulletin, 29(4), 791–801.PubMedCrossRef
Nyer, M., Kasckow, J., Fellows, I., Lawrence, E. C., Golshan, S., Solorzano, E., et al. (2010). The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Annals of Clinical Psychiatry, 22(3), 172–179.PubMed
Olfson, M., Marcus, S. C., & Doshi, J. A. (2010). Continuity of care after inpatient discharge of patients with schizophrenia in the medicaid program: A retrospective longitudinal cohort analysis. Journal of Clinical Psychiatry, 71(7), 831–838.PubMedCrossRef
Pathman, D. E., Konrad, T. R., King, T. S., Taylor, D. H., & Koch, G. (2004). Outcomes of states’ scholarships, loan repayment, and related programs for physicians. Medical Care, 42(6), 560–568.PubMedCrossRef
Pauly, M. V., & Pagán, J. A. (2007). Spillovers and vulnerability: The case of community uninsurance. Health Affairs, 26(5), 1304–1313.PubMedCrossRef
Phillips, K. A., Morrison, K. R., Andersen, R., & Aday, L. A. (1998). Understanding the context of healthcare utilization: Assessing environmental and provider-related variables in the behavioral model of utilization. Health Services Research, 33(3), 571–596.PubMedCentralPubMed
Quality Resource Systems. (2009). Health resources and services administration. Bureau of health professions. Area resource file(ARF) system. Fairfax, VA: Quality Resource Systems.
Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50(2), 85–94.PubMedCrossRef
Reschovsky, J. D., & Staiti, A. B. (2005). Access and quality: Does rural America lag behind? Health Affairs, 24(4), 1128–1139.PubMedCrossRef
Robert, S. A. (1999). Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology, 25(1), 489–516.CrossRef
Rosenberg, S. D., Goodman, L. A., Osher, F. C., Swartz, M. S., Essock, S. M., Butterfield, M. I., et al. (2001). Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. American Journal of Public Health, 91(1), 31–37.PubMedCentralPubMedCrossRef
Salzer, M. S., Nixon, C. T., Schut, L. J., Karver, M. S., & Bickman, L. (1997). Validating quality indicators: Quality as relationship between structure, process, and outcome. Evaluation Review, 21(3), 292–309.PubMedCrossRef
Schraufnagel, T. J., Wagner, A. W., Miranda, J., & Roy-Byrne, P. P. (2006). Treating minority patients with depression and anxiety: What does the evidence tell us? General Hospital Psychiatry, 28(1), 27–36.PubMedCrossRef
Singh, S. P., & Fisher, H. L. (2005). Early intervention in psychosis: Obstacles and opportunities. Advances in Psychiatric Treatment, 11(1), 71–78.CrossRef
Stein, B. D., Kogan, J. N., Sorbero, M. J., Thompson, W., & Hutchinson, S. L. (2007). Predictors of timely follow-up care among medicaid-enrolled adults after psychiatric hospitalization. Psychiatric Services, 58(12), 1563–1569.PubMedCrossRef
Test, M. A. (1979). Continuity of care in community treatment. New Directions for Mental Health Services, 2, 15–23.CrossRef
Van Voorhees, B. W., Walters, A. E., Prochaska, M., & Quinn, M. (2007). Reducing health disparities in depressive disorders outcomes between non-hispanic whites and ethnic minorities. Medical Care Research and Review, 64(5), 157S–194S.PubMedCrossRef
Vladeck, B. C. (2001). You can’t get there from here: Obstacles to improving care of the chronically ill. Health Affairs, 20(6), 175–179.PubMedCrossRef
Wagenfeld, M. O., Murray, J. D., Mohatt, D. F., & DeBruyn, J. C. (1994). Mental health and rural America, 1980–1993: An overview and annotated bibliography. Rockville, MD: Office of Rural Health Policy, Health Resources and Services Administration.
Wagner, E. H., Austin, B. T., & Von Korff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly, 74(4), 511–544.PubMedCrossRef
Wang, P. S., Berglund, P., & Kessler, R. C. (2000). Recent care of common mental disorders in the United States: Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15(5), 284–292.PubMedCentralPubMedCrossRef
Wennberg, D. E., & Wennberg, J. E. (2003). Addressing variations: Is there hope for the future? Health Affairs, Suppl Web Exclusives, w3.614–w3.617.
West, J. C., Wilk, J. E., Olfson, M., Rae, D. S., Marcus, S., Narrow, W. E., et al. (2005). Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatric Services, 56(3), 283–291.PubMedCrossRef
Wierdsma, A., Mulder, C., De, V. S., & Sytema, S. (2009). Reconstructing continuity of care in mental health services: A multilevel conceptual framework. Journal of Health Services Research and Policy, 14(1), 52–57. doi:10.​1258/​jhsrp.​2008.​008039.PubMedCrossRef
Young, G. J., Mohr, D. C., Meterko, M., Seibert, M. N., & McGlynn, G. (2006). Psychiatrists’ self-reported adherence to evidence-based prescribing practices in the treatment of schizophrenia. Psychiatric Services, 57(1), 130–132.PubMedCrossRef
Young, A. S., Sullivan, G., Burnam, M. A., & Brook, R. H. (1998). Measuring the quality of outpatient treatment for schizophrenia. Archives of General Psychiatry, 55(7), 611–617.PubMedCrossRef
Young, A. S., Sullivan, G., & Duan, N. (1999). Patient, provider, and treatment factors associated with poor-quality care for schizophrenia. Mental Health Services Research, 1(4), 201–211.PubMedCrossRef
Metadata
Title
Individual and Contextual-Level Factors Associated with Continuity of Care for Adults with Schizophrenia
Authors
Cynthia A. Fontanella
Joseph Guada
Gary Phillips
Lorin Ranbom
John C. Fortney
Publication date
01-09-2014
Publisher
Springer US
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 5/2014
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-013-0500-x

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