Background: Care coordination has been identified as a critical component in improving quality of care and patient experience within the health care system. Such care coordination has been conceptualized around domains such as the use of in-patient case managers, medication reconciliation at transitions of care, predictive analytics to identify high-volume, high-cost patients, home visits, and the use of innovative care delivery models such as Accountable Care Organizations and Patient Centered Medical Homes.
Goal: The goal of this poster is to assess general hospitals' linkages to behavioral health services and use of care coordination practices.
Objectives: Using data from the American Hospital Association Survey of Care Systems and Payment for 2015, we examine the Care Coordination Index of hospitals that provided linkages to behavioral health care, whether directly through ownership, through contracts, or who responded that they did not link to behavioral health care.
Approach: A summary Care Coordination Index (CCI) score of for care coordination provision was calculated based upon the 12 categories established by the American Hospital Association. The maximum possible score was 60, meaning an extremely high level of care coordination was provided by the hospital and the minimum was 1, meaning only one type of care coordination was provided and that this occurred only infrequently. There was a total of 1,355 general hospitals in the sample that reported on their care coordination activities. The mean CCI score for general hospitals was 35.95 (range 1-60, standard deviation, 9.91). Hospitals were divided into 2 groups, those with 100 or more beds, or those with 99 or fewer beds. Among hospitals with 100 or more beds, the mean CCI was 38.31. Among hospitals with 99 or fewer beds, the CCI was 32.32.
Results: A total of 729 hospitals owned or provided behavioral health care through their system. Another 270 provided behavioral healthcare through their networks or through a formal contractual arrangement/joint venture. A total of 341 general hospitals did not link to behavioral health care. We tested the relationship between hospital bedsize and owning or contracting for behavioral health care, finding that larger bedsize hospitals were more likely to own behavioral health practices; smaller bedsize hospitals were more likely to not link to, contract for, or own outpatient behavioral health services (p for trend <0.001). Most general hospitals have some business arrangement to provide behavioral health services. Smaller bedsize hospitals offered fewer care coordination activities and were less likely to link to behavioral care.
Importance to public health: Hospital bed size appears to have an important relationship with care coordination provision and linkages to behavioral health. More research is needed to determine how smaller hospitals can effectively link to behavioral health care and coordinate patient care.