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22-07-2022 | Mood Disorders | Original Research

Association Between Mental Health Conditions and Outpatient Care Fragmentation: a National Study of Older High-Risk Veterans

Authors: Ranak B. Trivedi, PhD, Fernanda S. Rossi, PhD, Sarah J. Javier, PhD, Liberty Greene, MS, MEd, Sara J. Singer, PhD, Megan E. Vanneman, PhD, MPH, Mary Goldstein, MD, Donna M. Zulman, MD, MS

Published in: Journal of General Internal Medicine | Issue 16/2022

Abstract

Background

Healthcare fragmentation may lead to adverse consequences and may be amplified among older, sicker patients with mental health (MH) conditions.

Objective

To determine whether older Veterans with MH conditions have more fragmented outpatient non-MH care, compared with older Veterans with no MH conditions.

Design

Retrospective cohort study using FY2014 Veterans Health Administration (VHA) administrative data linked to Medicare data.

Participants

125,481 VHA patients ≥ 65 years old who were continuously enrolled in Medicare Fee-for-Service Parts A and B and were at high risk for hospitalization.

Main Outcome and Measures

The main outcome was non-MH care fragmentation as measured by (1) non-MH provider count and (2) Usual Provider of Care (UPC), the proportion of care with the most frequently seen non-MH provider. We tested the association between no vs. any MH conditions and outcomes using Poisson regression and fractional regression with logit link, respectively. We also compared Veterans with no MH condition with each MH condition and combinations of MH conditions, adjusting for sociodemographics, comorbidities, and drive-time to VHA specialty care.

Key Results

In total, 47.3% had at least one MH condition. Compared to those without MH conditions, Veterans with MH conditions had less fragmented care, with fewer non-MH providers (IRR = 0.96; 95% CI: 0.96–0.96) and more concentrated care with their usual provider (OR = 1.08 for a higher UPC; 95% CI: 1.07, 1.09) in adjusted models. Secondary analyses showed that those with individual MH conditions (e.g., depression) had fewer non-MH providers (IRR range: 0.86–0.98) and more concentrated care (OR range: 1.04–1.20). A similar pattern was observed when examining combinations of MH conditions (IRR range: 0.80–0.90; OR range: 1.16–1.30).

Conclusions

Contrary to expectations, having a MH condition was associated with less fragmented non-MH care among older, high-risk Veterans. Further research will determine if this is due to different needs, underuse, or appropriate use of healthcare.

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Title: Association Between Mental Health Conditions and Outpatient Care Fragmentation: a National Study of Older High-Risk Veterans
Authors: Ranak B. Trivedi, PhD
Fernanda S. Rossi, PhD
Sarah J. Javier, PhD
Liberty Greene, MS, MEd
Sara J. Singer, PhD
Megan E. Vanneman, PhD, MPH
Mary Goldstein, MD
Donna M. Zulman, MD, MS
Publication date: 22-07-2022
Publisher: Springer International Publishing
Keywords: Mood Disorders
Care
Affective Disorder
Published in: Journal of General Internal Medicine / Issue 16/2022
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-022-07705-z

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