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HSR&D 2004 National Meeting Abstracts


4003. Mental Health Care Coordination & Referral in VA Primary Care Facilities
Amy Kilbourne, PhD, MPH, Center for Health Equity Research and Promotion, VA Pittsburg Healthcare System and University of Pittsburg, EM Yano, VA Greater Los Angeles HSR&D Center of Excellence and UCLA School of Public Health, JE Kirchner, MIRECC, VA South Central Healthcare System, K Schutte, Center for Healthcare Evaluation, VA Palo Alto Healthcare System, GL Haas, MIRECC, VA Pittsburg Healthcare System and University of Pittsburg

Objectives: Evidence suggests that the quality of care for mental disorders is suboptimal. Appropriate coordination of specialty treatment is imperative for improving the quality of care and outcomes for patients with mental disorders. However, in primary care, decisions to coordinate (i.e., joint management) versus refer to mental health services may be influenced by system-level factors in the VA, independent of guideline recommendations. Nonetheless, there is a dearth of research characterizing the system-level factors associated with the coordination and referral of mental health care, and how they subsequently impact patient quality.

Methods: We define a conceptual framework for characterizing the primary care system-level factors associated with the coordination of care for veterans with mental disorders. We discuss key system-level inputs (e.g., personnel, external environment, information technology) and processes (e.g., profiling, practice authority, communication, longitudinal care) that vary across VA facilities, which may be associated with referral or coordination of mental health care across different mental disorders (depression, bipolar disorder, psychosis, and substance abuse).

Results: Using data from the 1999 VA Primary Care Practice Survey, we compare these system-level determinants of coordination versus referral in VA primary care practices for different mental disorders. Focusing on bipolar disorder, we evaluate the system-level factors associated with referral versus joint management, and ultimately patient-level quality of care (appropriate pharmacotherapy, outpatient and inpatient utilization).

Conclusions: A better understanding of the determinants of coordinated care for mental disorders will inform VA policymakers in designing appropriate mental health integration treatment models and tailoring them across different VA facilities.

Panel: Ira Katz, MD, PhD Gerald Goldstein PhD David Oslin MD Joseph Conigliaro MD, MPH Amy Kilbourne, PhD, MPH Gretchen Haas, PhD