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Local Health Departments’ Promotion of Mental Health Care and Reductions in 30-Day All-Cause Readmission Rates in Maryland

Chen, Jie, PhD*; Novak, Priscilla, MPH*; Barath, Deanna, MPH*; Goldman, Howard, MD, PhD; Mortensen, Karoline, PhD

doi: 10.1097/MLR.0000000000000850
Original Articles

Background: Individuals affected with mental health conditions, including mood disorders and substance abuse, are at an increased risk of hospital readmission.

Objectives: The objective of this study is to examine whether local health departments’ (LHDs) active roles of promoting mental health are associated with reductions in 30-day all-cause readmission rates, a common quality metric.

Methods: Using datasets linked from multiple sources, including 2012–2013 State Inpatient Databases for the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Health Resource File, and US Census data, we employed multivariate logistic models to examine whether LHDs’ active provision of mental health preventive care, mental health services, and health promotion were associated with the likelihood of having any 30-day all-cause readmission.

Results: Multivariate logistic regressions showed that LHDs’ provision of mental health preventive care, mental health services, and health promotion were negatively associated with the likelihoods of having any 30-day readmission for adults 18–64 years old (odds ratios=0.71–0.82, P<0.001), and adults 65 and above (odds ratios=0.61–0.63, P<0.001, preventive care and services, respectively). These estimated associations were more prominent among individuals with mental illness and/or substance use disorders, African Americans, Medicare, and Medicaid enrollees.

Conclusions: Our results suggest that LHDs in Maryland that engage in mental health prevention, promotion, and coordination activities are associated with benefits for residents and for the health care system at large. Additional research is needed to evaluate LHD activities in other states to determine if these results are generalizable.

*Department of Health Services Administration, School of Public Health, University of Maryland, College Park

Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD

Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables, FL

J.C. and H.G. are supported by NIH-National Institute of Mental Health (R21MH106813-01, J.C., PI).

P.V. wishes to disclose that she is an employee of the Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this manuscript are those of the authors and do not necessarily represent the positions of AHRQ, the Department of Health and Human Services, or the US federal government. The remaining authors declare no conflict of interest.

Reprints: Jie Chen, PhD, Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD. E-mail: jichen@umd.edu.

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