The 130th Annual Meeting of APHA

Abstract #42446

Greg Greenberg, Phd, Northeast Program Evaluation Center, VAMC West Haven, Ct. as well as Yale University Department of Psychiatry, New Haven, CT., VA Northeast Program Evaluation Center /182, 950 Campbell Ave, New haven, CT 06511, 203-789-0487, greenberg@biomed.med.yale.edu and Robert Rosenheck, MD, Psychiatry and Public Health, Yale University, Building 8, 950 Campbell Ave, West Haven, CT 06516.

To investigate factors that managers can alter to improve continuity of care (COC) we used a facility-level administrative data set containing information on 139 VA medical centers over a six-year period and supplemental data on environmental factors. Simple correlations were first used to examine bivariate associations between eight COC measures and nine measures of the institutional environment and the social context. Next, to control for potential autocorrelation multivariate hierarchical linear models with all nine independent measures were conducted. The strongest predictors of COC were per capita outpatient expenditure and the percentage of all mental health expenditures devoted to outpatient care. The former was associated with higher COC on 6 of 8 measures and the later on 7 of 8 measures. Community social capital, which assesses the degree of civic involvement and trust at the state level was associated with greater COC on five measures. An indicator of the degree to which non-VA mental health services are available in a state was unexpectedly associated with greater VA COC on six measures. In HLM analysis significant relationships with COC remained for outpatient per capita expenditures, overall outpatient emphasis, and social capital but not for non-VA mental health funding. A linear term representing the year was positively associated with all four of the examined continuity of care measures, indicating improvement in continuity of care for the period under study, although the explanation for this trend is unclear. We concluded that several factors potentially under managerial control are associated with increased mental health COC.

Learning Objectives:

• Have a clear understanding of some of the factors under managerial control that can influence continuity of care.
• Have a better understanding of the degree to which environmental factors are relevant to maintaining client continuity of care.

Keywords: Mental Health,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Department of Veterans Affairs
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment by the Department of Veterans Affairs