TY - JOUR
KW - Quality of Care
KW - Research/service delivery
KW - Mental Health Services
AU - R. Trivedi
AU - P. Sylling
AU - E. P. Post
AU - E. S. Wong
AU - A. M. Mori
AU - S. D. Fihn
AU - K. Nelson
A1 - 
AB - OBJECTIVES: The authors examined whether the rate of preventable hospitalizations among veterans with mental illness changed after implementation of the Department of Veterans Affairs (VA) primary care medical home-Patient Aligned Care Teams (PACT). METHODS: A 12-year retrospective cohort analysis was conducted of data from 9,206,017 veterans seen in 942 VA primary care clinics between October 2003 and March 2015. Preventable hospitalizations were those related to ambulatory care-sensitive conditions (ACSCs), identified with ICD-9 codes. Changes in rates of ACSC-related hospitalizations were compared between patients with and without mental illness in two age groups (/=65). Patients with mental illness diagnoses were grouped as follows: depression, posttraumatic stress disorder, anxiety, substance use disorder, and serious mental illness. Interrupted time-series analysis was used to model long-term trends and detect deviations after PACT implementation. RESULTS: There was an overall increase in mental illness diagnoses across both age groups. Among older veterans (>/=65) with any mental illness, the rate (per 1,000 patients) of ACSC-related hospitalizations was five fewer in the post-PACT period, compared with the pre-PACT period. Among younger veterans (<65), there was a slight increase in ACSC-related hospitalizations in years 3-5 post-PACT if they had any mental illness (.6 per 1,000 patients), depression (.3), anxiety (1.4), or a substance use disorder (.6). CONCLUSIONS: In this retrospective, observational study examining large systemwide changes in clinical practice, mental illness was more likely to be diagnosed after PACT implementation, compared with before, and results suggested a benefit of PACT implementation among older veterans in terms of a reduction in ACSC-related hospitalizations.
AD - Dr. Trivedi is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. She is also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California. Mr. Sylling, Dr. Wong, Ms. Mori, and Dr. Nelson are with the Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle. Dr. Wong and Dr. Nelson are also with the University of Washington, Seattle, where Dr. Wong is with the Department of Health Services and Dr. Nelson, along with Dr. Fihn, is with the Department of General Internal Medicine. Dr. Post is with the Center for Clinical Management Research, VA Ann Arbor Health Care System and the Department of Internal Medicine, University of Michigan, Ann Arbor.; Dr. Trivedi is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. She is also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California. Mr. Sylling, Dr. Wong, Ms. Mori, and Dr. Nelson are with the Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle. Dr. Wong and Dr. Nelson are also with the University of Washington, Seattle, where Dr. Wong is with the Department of Health Services and Dr. Nelson, along with Dr. Fihn, is with the Department of General Internal Medicine. Dr. Post is with the Center for Clinical Management Research, VA Ann Arbor Health Care System and the Department of Internal Medicine, University of Michigan, Ann Arbor.; Dr. Trivedi is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. She is also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California. Mr. Sylling, Dr. Wong, Ms. (TRUNCATED)
BT - Psychiatric services (Washington, D.C.)
C5 - Medical Home
CP - 12
CY - United States
DO - 10.1176/appi.ps.201700316
IS - 12
JF - Psychiatric services (Washington, D.C.)
M1 - Journal Article
N2 - OBJECTIVES: The authors examined whether the rate of preventable hospitalizations among veterans with mental illness changed after implementation of the Department of Veterans Affairs (VA) primary care medical home-Patient Aligned Care Teams (PACT). METHODS: A 12-year retrospective cohort analysis was conducted of data from 9,206,017 veterans seen in 942 VA primary care clinics between October 2003 and March 2015. Preventable hospitalizations were those related to ambulatory care-sensitive conditions (ACSCs), identified with ICD-9 codes. Changes in rates of ACSC-related hospitalizations were compared between patients with and without mental illness in two age groups (/=65). Patients with mental illness diagnoses were grouped as follows: depression, posttraumatic stress disorder, anxiety, substance use disorder, and serious mental illness. Interrupted time-series analysis was used to model long-term trends and detect deviations after PACT implementation. RESULTS: There was an overall increase in mental illness diagnoses across both age groups. Among older veterans (>/=65) with any mental illness, the rate (per 1,000 patients) of ACSC-related hospitalizations was five fewer in the post-PACT period, compared with the pre-PACT period. Among younger veterans (<65), there was a slight increase in ACSC-related hospitalizations in years 3-5 post-PACT if they had any mental illness (.6 per 1,000 patients), depression (.3), anxiety (1.4), or a substance use disorder (.6). CONCLUSIONS: In this retrospective, observational study examining large systemwide changes in clinical practice, mental illness was more likely to be diagnosed after PACT implementation, compared with before, and results suggested a benefit of PACT implementation among older veterans in terms of a reduction in ACSC-related hospitalizations.
PP - United States
PY - 2018
SN - 1557-9700; 1075-2730
SP - 1252
EP - 1258
EP - 
T1 - Comparing Preventable Hospitalizations Among Veterans With and Without Mental Illnesses Before and After Implementation of PACT
T2 - Psychiatric services (Washington, D.C.)
TI - Comparing Preventable Hospitalizations Among Veterans With and Without Mental Illnesses Before and After Implementation of PACT
U1 - Medical Home
U2 - 30301446
U3 - 10.1176/appi.ps.201700316
VL - 69
VO - 1557-9700; 1075-2730
Y1 - 2018
Y2 - Dec 1
ER -