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23.05.2021 | Original Research

Association of Team-Based Care and Continuity of Care with Hospitalizations for Veterans with Comorbid Mental and Physical Health Conditions

verfasst von: Hayley D. Germack, PhD MHS RN, Lucinda Leung, MD PhD MPH, Xinhua Zhao, PhD, Hongwei Zhang, MS, Grant R. Martsolf, PhD MPH RN FAAN

Erschienen in: Journal of General Internal Medicine | Ausgabe 1/2022

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Abstract

Background

Integrating mental health in primary care settings is associated with improved screening and detection of mental illness. In 2010, the Veterans Health Administration launched a patient-centered medical home (PCMH) model nationally across all clinical sites that integrated mental health into primary care—the Patient Aligned Care Team (PACT) initiative. Team-based delivery of continuous primary and mental health care, as found in effective collaborative care models, is thought to be crucial to managing veterans with mental health disorders. The association between clinic implementation of specific aspects of PACT and clinical outcomes of veterans with mental health disorders remains unknown.

Objective

To examine the association between clinic implementation of team-based care and continuity of care and subsequent hospitalizations among veterans with mental health disorders.

Design

Retrospective cohort study.

Patients

A total of 1,444,942 veterans with comorbid mental health disorders and physical health conditions receiving primary care in 831 VA PACT clinics in fiscal year (FY) 2015.

Main Measures

We examined the clinic-level implementation of team-based care and continuity of care in the clinic where veterans received their primary care. Our primary outcome was any hospitalization in the VA or fee-based service in FY2016. We examined the impact of clinic-level implementation of team-based care and continuity of care on having a hospitalization, adjusting for patient demographic, clinical characteristics, and facility characteristics.

Key Results

Veterans receiving care in clinics with the greatest versus lowest quartile of implementation of team-based care had lower rates of hospitalization (8.8% vs. 12.3%; adjusted OR = 0.92, 95% CI 0.85–0.99, p < 0.035). There was not a statistically significant association between clinic-level implementation of continuity of care and hospitalization.

Conclusions

Veterans receiving care in clinics with greater implementation of team-based care had statistically significant lower rates of hospitalization.

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Titel: Association of Team-Based Care and Continuity of Care with Hospitalizations for Veterans with Comorbid Mental and Physical Health Conditions
verfasst von: Hayley D. Germack, PhD MHS RN
Lucinda Leung, MD PhD MPH
Xinhua Zhao, PhD
Hongwei Zhang, MS
Grant R. Martsolf, PhD MPH RN FAAN
Publikationsdatum: 23.05.2021
Verlag: Springer International Publishing
Erschienen in: Journal of General Internal Medicine / Ausgabe 1/2022
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-021-06884-5

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Abstract

Background

Objective

Design

Patients

Main Measures

Key Results

Conclusions

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