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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1062 — Co-Location of General Medical Services in Mental Health for Veterans with Serious Mental Illness and Ambulatory Care-Sensitive Hospital Admissions

Pirraglia PA (Providence VA Medical Center, Systems Outcomes and Quality in Chronic Disease and Rehabilitation (SOQCR) Program), Lai Z (VA Ann Arbor National Serious Mental Illness Treatment Resource and Evaluation Center), Friedmann PD (Providence VA Medical Center, SOQCR), O'Toole TP (Providence VA Medical Center, SOQCR), Kilbourne AM (VA Ann Arbor National Serious Mental Illness Treatment Resource and Evaluation Center)

The purpose of this study was to examine whether veterans with serious mental illness (SMI) receiving care at VA mental health programs with co-located general medical services had fewer medical/surgical hospitalizations for ambulatory care sensitive conditions (ACSC) than those receiving care in mental health programs without co-located care. ACSC’s are “conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease.”

We performed a cross sectional study of veterans with SMI at 108 VA sites in FY2007. Using information from a 2007 survey of VA Mental Health Programs, we classified sites as having general medical services co-located in the mental health program or not. We examined the count of ACSC hospitalizations at co-located versus non-co-located sites using zero-inflated negative binomial regression that controlled for patient-level characteristics of age, gender, race/ethnicity, marital status, VA service connection, Charlson-Deyo comorbidity index score, psychiatric diagnoses, and facility level characteristics of size, rurality, and academic affiliation. The analysis adjusted for clustering at the facility level.

Of 92,268 veterans with SMI, 9,662 received care at 10 co-located sites and 82,604 at 98 non-co-located sites. 5.1% of veterans in non-co-located sites had at least one ACSC hospital admission versus 4.3% in co-located sites. Regression analysis revealed that co-location was associated with a lower ACSC hospitalization count of 0.75 (? = -0.28, 95% CI 0.47 to -0.09, p = 0.004).

Co-location of general medical services in the mental health location was independently associated with fewer ACSC hospitalizations among a national cohort of VA patients with SMI. This finding suggests that this program of care may result in a lower rate of potentially preventable hospital admissions.

Currently, the VA has prioritized the widespread adoption of co-located collaborative mental health services within primary care as part of the Primary Care-Mental Health Integration clinical mandate. Similarly, implementation of co-located medical care or similar patient-centered medical care management models in mental health settings may reduce potential disparities in health outcomes through improved coordination and continuity of care for this vulnerable group.

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