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2019 HSR&D/QUERI National Conference Abstract

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4061 — Health Status and Non-VHA Healthcare Utilization of Veterans Contacted through SMI Re-Engage

Lead/Presenter: Stephanie Merrill,  Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)
All Authors: Merrill SL (Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention), Abraham KM (Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention; University of Detroit Mercy), Mach J (Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention) Quasarano JG (Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention)

Objectives:
SMI Re-Engage is a population-based outreach program designed to facilitate return to care for Veterans with serious mental illness (schizophrenia or bipolar disorder) who have not received VHA healthcare for at least twelve months. The program was developed in response to prior research that found a lack of engagement in VHA care is associated with poor health outcomes for this population. However, little is known about the health status and non-VHA healthcare utilization of Veterans with serious mental illness who are lost to VHA care. The purpose of this evaluation was to describe the non-VHA healthcare utilization and health status of Veterans contacted through SMI Re-Engage.

Methods:
This evaluation relied on data gathered from standard SMI Re-Engage program processes. When clinicians contact Veterans, they ask a series of questions regarding health status and disposition. This evaluation used data from Veterans (N = 2,035) who were contacted and responded to questions between April 2016 - June 2018. Descriptive statistics regarding Veteran self-reported health status and healthcare utilization were calculated. Demographic information was obtained from the Corporate Data Warehouse.

Results:
Over one-third (36.5%) of Veterans reported originally leaving VHA care because they were accessing non-VA care. In the year preceding SMI Re-Engage contact, 62.11% of Veterans did not visit a provider for mental health reasons, and 46.61% did not have a usual place where they receive mental health care. Similarly, 41.37% of Veterans did not visit a provider for physical health reasons, and 34.58% did not have a usual place where they receive medical care. In terms of health status, 45.35% of Veterans reported "good" general health; 36.05% of Veterans reported "fair" or "poor" general health.

Implications:
Over one-third of Veterans contacted through SMI Re-Engage reported leaving VHA care to access non-VHA care, yet a substantial proportion of Veterans did not access primary care (41.37%) and mental health care (62.11%) during the twelve-month period when they were lost to VHA care.

Impacts:
A substantial proportion of Veterans with serious mental illness lost to VHA care do not access non-VHA medical or mental health care. Continued efforts are needed to improve care continuity for Veterans with serious mental illness.