The authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs, Ann Arbor, Michigan. Dr. Abraham is also with the Department of Psychology, University of Detroit Mercy, Detroit. Dr. McCarthy is also with the Department of Psychiatry, University of Michigan, Ann Arbor.
Psychiatr Serv. 2018 Aug 1;69(8):887-895. doi: 10.1176/appi.ps.201700407. Epub 2018 May 25.
This evaluation assessed the effectiveness of the Veterans Health Administration (VHA) program Reengaging Veterans With Serious Mental Illness in Treatment (SMI Re-Engage). The program serves veterans with serious mental illness who experience extended gaps in use of VHA care.
Propensity score-weighted survival analysis that adjusted for demographic, clinical, and utilization factors assessed whether being contacted via SMI Re-Engage predicted return to VHA care within 18 months of when clinicians received patient contact information and, among veterans contacted, whether return to VHA care was associated with mortality risk within the 18-month follow-up period. Among all veterans who returned to care, a post hoc propensity score-weighted logistic regression that adjusted for demographic, clinical, and utilization factors assessed whether being contacted via SMI Re-Engage was associated with returning to outpatient care versus inpatient or emergency care.
Of veterans contacted (N=886), 42% returned to care, compared with 27% of veterans whom providers attempted to contact but could not reach (N=2,059). When analyses adjusted for covariates, veterans who were contacted had a higher risk of returning to care (hazard ratio (HR)=3.40, 95% confidence interval [CI]=2.70-4.28). Among veterans contacted, the association between return to VHA care and mortality risk was not significant. Post hoc analyses for veterans who returned to care (N=941) indicated that being contacted (versus not being contacted) was associated with higher odds of returning to outpatient care (versus inpatient or emergency care) (odds ratio=2.42, CI=1.68-3.47).
SMI Re-Engage contact facilitated return to VHA care. SMI Re-Engage exemplifies how population health strategies can address health care discontinuities among people with serious mental illness.
本评估旨在评估退伍军人健康管理局（VHA）项目“重新接纳患有严重精神疾病的退伍军人参与治疗（SMI 重新参与）”的有效性。该项目服务于经历 VHA 护理使用时间延长的严重精神疾病退伍军人。
采用倾向评分加权生存分析，调整人口统计学、临床和利用因素，评估通过 SMI 重新参与联系是否预测临床医生收到患者联系信息后 18 个月内返回 VHA 护理，以及在联系的退伍军人中，返回 VHA 护理是否与 18 个月随访期间的死亡风险相关。在所有返回护理的退伍军人中，一项事后倾向评分加权逻辑回归分析，调整人口统计学、临床和利用因素，评估通过 SMI 重新参与联系是否与返回门诊护理而不是住院或急诊护理相关。
在联系的退伍军人中（n=886），42%的人返回护理，而提供者试图联系但无法联系到的退伍军人（n=2059）中，有 27%的人返回护理。在调整协变量后，被联系的退伍军人返回护理的风险更高（风险比[HR]=3.40，95%置信区间[CI]=2.70-4.28）。在联系的退伍军人中，返回 VHA 护理与死亡风险之间的关联不显著。对于返回护理的退伍军人（n=941）的事后分析表明，与未被联系的退伍军人相比，被联系（而非未被联系）与返回门诊护理（而非住院或急诊护理）的可能性更高（优势比=2.42，CI=1.68-3.47）。
SMI 重新参与联系促进了返回 VHA 护理。SMI 重新参与为如何通过人群健康策略解决严重精神疾病患者的医疗保健间断问题提供了范例。
