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Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities.

ABSTRACT: INTRODUCTION:Serving as the center of community-engaged health programs, local health departments can play a critical role in promoting community mental health. The objectives of this study were to explore the association between local health department activities and (1) preventable hospitalizations for individuals with mental disorders, and (2) associated racial disparities in preventable hospitalizations. METHOD:Employing the linked data sets of the 2012-2013 Healthcare Cost and Utilization Project state inpatient discharge file of the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Resource File, and U.S. Census data, the authors estimated the association between local health department activities (i.e., provision of mental health preventive care and community mental health promotion) and the reduction of the preventable hospitalizations for ambulatory care-sensitive conditions and coexisting mental disorders. All the data analyses were conducted during September 2016-August 2017. RESULTS:Multilevel regression showed that local health departments' provision of mental health preventive care (OR=0.76, 95% CI=0.63, 0.92) and mental health promotion activities (OR=0.77, 95% CI=0.62, 0.94) were significantly associated with lower rates of preventable hospitalizations for individuals with ambulatory care-sensitive conditions and coexisting mental disorders. Decomposition results suggested that local health departments' direct provision of mental health preventive care could reduce 9% of the racial disparities. CONCLUSIONS:Improving care coordination and integration are essential to meeting the growing demands for healthcare access, while controlling costs and improving quality of service delivery. These results suggest that it will be effective to engage local health departments in the integrated behavioral health system.

SUBMITTER: Chen J

PROVIDER: S-EPMC5807070 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities.

Chen Jie J Bloodworth Robin R Novak Priscilla P Cook Benjamin Le BL Goldman Howard H HH Rendall Michael S MS Thomas Stephen B SB Reynolds Charles F CF

American journal of preventive medicine 20180101 1

<h4>Introduction</h4>Serving as the center of community-engaged health programs, local health departments can play a critical role in promoting community mental health. The objectives of this study were to explore the association between local health department activities and (1) preventable hospitalizations for individuals with mental disorders, and (2) associated racial disparities in preventable hospitalizations.<h4>Method</h4>Employing the linked data sets of the 2012-2013 Healthcare Cost an ...[more]

PMID: 29254550

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Project description:BACKGROUND:Since 2000, a series of national policies have been released to tackle mental health problems in China; however, their promotion and implementation at local level are under-evaluated. This study will evaluate the case of Liuyang Municipality, to present a deeper understanding of China's problems and lessons on implementation of mental health policy in developing countries. METHODS:A rapid appraisal was conducted on Liuyang's mental health policy and plan, under two evaluation frameworks: (1) the WHO checklists for mental health policy and plan, (2) activities and time frames stated in Liuyang's mental health policy and plan. Documentation review, semi-structured interviews with nine key informants, and surveys on 32 front-line implementers were performed. Descriptive statistics and framework analysis were employed respectively to analyze quantitative and qualitative data. RESULTS:As a local-level promotion of national mental health policies, Liuyang's mental health policy and plan had evidence base and received highest-level approval within local health system, but without stakeholders' consultation. The vision, principles and objectives were consistent with national policies. Twelve WHO-suggested areas for actions were unequally covered. Policy content had operational defects of lacking necessary details on evaluation, funding and activity. For implementation, health departments generally outperformed non-health ones. Discrepancies between planning and practices, and uneven regional implementation compromised implementation quality. Insufficient and poorly trained human resources, unguaranteed funding and low client acceptability were identified as implementation barriers. CONCLUSIONS:The case of Liuyang is an active attempt to promote and implement national mental health policies at local level. As a reflection of mental health policy in China and developing countries, its highlights and problems demonstrate that evidence base, high-level approval, multi-sector involvement, operational content, and clear focuses promote policy implementation.

Project description:BACKGROUND:Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. METHODS/DESIGN:This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. DISCUSSION:Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. TRIAL REGISTRATION:ClinicalTrials.gov: NCT01407926.

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Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities.

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Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities.

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