220430 Gaps in continuity of care: Homelessness and incarceration among Medicaid psychiatric patients

Wednesday, November 10, 2010 : 1:30 PM - 1:45 PM

Eve Moscicki, ScD, MPH , Practice Research Network, American Psychiatric Institute for Research and Education, Arlington, VA
Joyce West, PhD, MPP , Practice Research Network, American Psychiatric Institute for Research and Education, Arlinton, VA
Farifteh Duffy, PhD , Practice Research Network, American Psychiatric Institute for Research and Education, Arlington, VA
Donald Rae, MS , Practice Research Network, American Psychiatric Institute for Research and Education, Arlington, VA
Maritza Rubio-Stipec, ScD , Practice Research Network, American Psychiatric Institute for Research and Education, Arlington, VA
Darrel Regier, MD, MPH , American Psychiatric Institute for Research and Education, Arlington, VA
Objective: Examine risk and identified potential gaps in continuity of care for homelessness and incarceration among psychiatric patients in ten states. Method: 4,866 psychiatrists in ten states were randomly selected from the AMA Physician Masterfile; 61% responded; 34% met study eligibility criteria and reported clinically detailed data on 1,625 systematically-selected patients. Multivariate logistic regression models examined odds of homelessness and incarceration controlling for sociodemographic and clinical characteristics. Results: Overall rates were 11.6% for homelessness (SE=1.3%) and 13.4 % for incarceration (SE=1.3%), with higher rates among males, non-whites, and young adults 18-30 years. Patients diagnosed with substance use (43% homeless, 38% incarcerated), alcohol use (36% homeless, 25% incarcerated), and schizophrenia (24% homeless, 22% incarcerated) disorders were at considerable risk. One-third of public and private inpatients experienced homelessness; one-third of public inpatients experienced incarceration; nearly 1 in 5 experienced both. One-quarter of patients with emergency department (ED) visits also experienced homelessness or incarceration. Patients with severe substance abuse symptoms, ED visits, or who were treated in the public sector had 2.0 (95% CI 1.3-3.1) to 6.1 (95% CI 2.1-17.9) increased likelihood of homelessness or incarceration. Patients who discontinued their medication had 2.4 (95% CI 1.3-4.4) increased odds of homelessness or incarceration. Conclusion: The findings highlight potential gaps in the mental health treatment infrastructure for patients with substance use, psychotic disorders, and psychiatric symptom exacerbation and suggests inpatient facilities and EDs treating Medicaid psychiatric patients could play a more effective role in preventing homelessness and incarceration through improved discharge planning and care coordination.

Learning Areas:
Chronic disease management and prevention
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Characterize Medicaid psychiatric patients who become homeless or incarcerated. Identify potential gaps in continuity of care for homelessness and incarceration in a large clinical sample of psychiatric patients in ten states.

Keywords: Health Care Access, Homelessness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the lead investigator on the analyses and paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.