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Continuing Care After Inpatient Psychiatric Treatment for Patients With Psychiatric and Substance Use Disorders

Dr. Ilgen is affiliated with Health Services Research and Development, Department of Veterans Affairs, 2215 Fuller Rd. (11H), Ann Arbor, MI 48105 (e-mail: marki{at}umich.edu), and with the Department of Psychiatry, University of Michigan, Ann Arbor. Ms. Hu, Dr. Moos, and Dr. McKellar are with the Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, California. Dr. Moos and Dr. McKellar are also with Stanford University School of Medicine, Palo Alto.

OBJECTIVE: This observational study examined the association between continuing outpatient care for a psychiatric disorder, a substance use disorder, or both and decreased risk of readmission to psychiatric care after an index episode of inpatient psychiatric treatment. METHODS: Treatment records from all patients with co-occurring substance use and psychiatric disorders discharged from an inpatient psychiatric setting in the Department of Veterans Affairs (VA) between July 1, 2004, and June 30, 2005 (N=26,826), were used to determine the impact of psychiatric and substance use disorder continuing care on readmission to inpatient psychiatric treatment in the 90 days after discharge. RESULTS: Over 23% (6,280 of 26,826) of patients with both a psychiatric disorder and a substance use disorder who received inpatient psychiatric treatment in the VA were readmitted for additional psychiatric care within 90 days of discharge. Survival analyses indicated that receiving continuing care for a substance use disorder (hazard ratio [HR]=.84, 95% confidence interval [CI]=.77–.92, p<.001) in the 30 days after discharge from the index episode was associated with a lower likelihood of rehospitalization. Psychiatric continuing care was not associated with risk of rehospitalization. A supplementary analysis indicated that substance use disorder continuing care was still associated with a reduced risk of rehospitalization over the 12 months after discharge, although the overall magnitude of the association was diminished (HR=.92, 95% CI=.86–.99, p=.02). CONCLUSIONS: Readmission to inpatient psychiatric treatment was common for patients with co-occurring disorders, and these observational findings indicate that continuing care for a substance use disorder was associated with lower risk of early readmission.

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