BACKGROUND: Outpatient follow-up visits after hospitalizations are suggested as a key intervention to reduce 30-day readmissions among persons with psychiatric disorders.

OBJECTIVES: To assess predictors of time to outpatient follow-up after hospitalization discharge and costs among Medicaid beneficiaries with bipolar disorder (BP) and/or schizophrenia (SCZ) utilizing second-generation antipsychotics (SGAs) after adjusting for demographic and clinical covariates.

METHODS: This cross-sectional time-series analysis utilized comprehensive administrative claims of adult Oklahoma Medicaid beneficiaries (≥18 years) with diagnosed and treated BP and/or SCZ between 01/01/2013-12/31/2017. Any-cause hospitalizations and psychiatry-related outpatient visits were identified through service and diagnosis codes. Predictors of time to outpatient follow-up and total direct medical costs were analyzed via generalized estimating equations, adjusting for demographics (age, sex, race, residence), comorbidities (Deyo-Charlson Index, obesity), year, BP or SCZ diagnoses, and oral (PO) or long-acting injectable (LAI) SGAs.

RESULTS: Overall, 468 members met inclusion criteria and incurred a hospitalization with a psychiatry-related outpatient follow-up visit. Members averaged 41.2±12.1 years of age and incurred $19,088±21,540 in costs, 75.0% were female, 32.1% involved claims with BP and SCZ, and 13.5% utilized LAIs. Some 37.2% had multiple hospitalizations, averaging 1.8±1.4 per member with a mean time to an outpatient follow-up of 2.4±2.9 months. Multivariable analysis indicated that LAI use was associated with a 23.9% shorter time to follow-up (p=0.034) and 16.4% lower costs (p=0.037) after adjusting for other demographic attributes, clinical factors, and time. More hospitalizations were also associated with shorter times to follow-up and higher costs (p<0.001).

CONCLUSIONS: This real-world assessment of Medicaid beneficiaries observed substantial time between hospital discharge to a subsequent psychiatry-related outpatient visit among those with BP or SCZ, with shorter times and lower costs associated with LAIs compared to oral agents. Continued work should seek to identify modifiable risk factors and interventions to improve patient outcomes and access to care.