Identifying risk factors and key strategies in linkage to outpatient psychiatric care

Objective: The substantial failure of psychiatric patients to engage in out patient specialty mental health care after an acute hospitalization at a ti me when managed care companies and others increasingly hold hospitals accou ntable for outcomes underscores the importance of identifying patients at h igh risk for not completing referrals. This study explored patient risk fac tors for not completing referrals and examined the success of several inter ventions targeted to achieving linkage with outpatient tare. Method: A clinically detailed, structured form was used in abstracting info rmation from the medical records of 229 inpatients with a primary psychiatr ic diagnosis. Clinicians and staff at outpatient programs were contacted to determine whether patients completed their referrals. Results: Approximately two-thirds (65%) of the patients failed to attend sc heduled or rescheduled initial outpatient mental health appointments after a hospital discharge. At high risk for unsuccessful linkage to outpatient c are were patients with a persistent mental illness and those who had no pri or public psychiatric hospitalization, were admitted involuntarily, and had longer lengths of stay. Controlling for risk factors, three clinical inter ventions used during the hospital stay more than tripled the odds of succes sful linkage to outpatient care: communication about patients' discharge pl ans between inpatient staff and outpatient clinicians, patients' starting o utpatient programs before discharge, and family involvement during the hosp ital stay. Conclusions: Effective clinical bridging strategies can be used to avoid un necessary gaps in the delivery of psychiatric services. incorporating these strategies into routine care would enhance continuity of care, especially for some high-risk patients.