Impact of Multiple Healthcare System Use on Psychiatric Outcomes in the State of Texas With One John Peter Smith Psychiatric Hospitalization

Purpose: In communities with more than one mental healthcare system, psychiatric patients often present to multiple systems of care, rather than receiving all care within one system. For instance, patients discharged from one inpatient setting may present soon after for additional care within a different facility. The purpose of this study is to characterize between-system patient utilization patterns and to study the ways in which these patterns are impacted by payor source and presenting problem. Methods: Using data from the Texas Health Care Information Collection's Inpatient Research Data File (THCIC-IP), we retrospectively examined psychiatric inpatient utilization patterns occurring in Texas with at least one admission at John Peter Smith Hospital for calendar years 2012-2014. Thirty-day readmissions for the same presenting problem were regarded as an indicator of poor outcome. Utilization patterns were analyzed by patient age, gender, payor source, primary diagnosis, level of comorbid health conditions and length of stay. Results: A total of 9,582 psychiatric illness episodes were treated within 82 inpatient specialty psychiatric treatment facilities in the state of Texas where at least one episode of care involved treatment at John Peter Smith Hospital during study years. This included 3,215 patients for whom primary focus of care was psychosis; 4,965 patients treated for a mood disorder and 1,260 patients treated for substance-related issues. Seeking treatment within multiple healthcare systems appeared to be more common for patients with certain kinds of presenting problems and primary payor sources. Outcomes also varied with treatment in multiple versus single care providers over time. Conclusion: These findings suggest that strategies to better educate consumers of psychiatric inpatient care about their local healthcare system alternatives and how choices may affect treatment outcome may be of benefit.