Background: Patients who are high utilizers of the health care system pose a significant burden to health care in the United States. These patients have higher rates of emergency department (ED) use, hospital readmission and cost compared to the general population, and tend to be medically, behaviorally and socially complex. Patients with high healthcare usage have been shown to have high rates of behavioral health disorders. One strategy to reduce health care usage in these patients is a multidisciplinary, patient-centered, transition of care program. Historically, such programs reduce ED visits and hospital readmission, but have not been successful in reducing cost. Bridges to Care (B2C) is an academic-community partnership developed to provide this care model to high utilizer patients in a low-income, urban area. This program specifically included a targeted behavioral health intervention for patients with a behavioral health condition.
Methods: 600 patients who identified as high utilizers of healthcar-defined as ≥3 ED visits or ≥2 hospital admissions over 6 month-were recruited to the B2C program beginning in 2012. Care plans were tailored to patients depending on each individual’s greatest need. The entire B2C intervention included ≥eight patient encounters over a minimum of sixty days. The behavioral health component included at least one behavioral health home visit, and a referral to a behavioral health provider if necessary. This study provides descriptive analyses of the behavioral health component of the B2C program. Primary measurements include major psychiatric diagnoses, the proportion of behavioral health home visits each patient received, “mentally unhealthy days” as assessed by patient report, and overall patient satisfaction as measured by the Clients Perception of Coordination Questionnaire (CPCQ).
Results:
N=504 (84%) of all B2C patients were found to have a behavioral health need. Of these, N=376 (63%) received a behavioral health home visit. The most common behavioral health diagnoses included depressive disorder NOS (28%), unspecified anxiety (26%), dysthymia (15%), PTSD (13%), bipolar disorder (10%) and panic disorder without agoraphobia (9%).
Of patients who graduated (N= 359) from the B2C program, N= 307 (86%) received a behavioral health home visit; of the patients who were lost to follow up (N=136), N=69 (51%) received a behavioral health home visit. Behavioral health visits made up 13% of all home visits in all B2C patients. N=249(80%) of patients who received the behavioral health intervention answered at least “sometimes” when asked if they were happy with the care they received. N=223(59%) of patients answered at least “moderately satisfied” when asked if they were satisfied with the behavioral health care they received.
In the behavioral intervention group, 59% of patients experienced a decrease in the number of “mentally unhealthy days”, while 29% experienced no change and 11% experienced an increase.
Conclusions: Our study demonstrates high rates of behavioral health disease among patients who are high utilizers of health care. These patients experience a diverse range of behavioral health conditions. A behavioral health intervention, including home visits and targeted behavioral health referrals, appears to be an effective tool in improving how patients perceived their own mental health, including a decrease in mentally unhealthy days. Patients reported overall satisfaction with care they received with the B2C intervention.