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Service delivery and quality of care for individuals with mental illness

Gopalan, Kalyani (2017) Service delivery and quality of care for individuals with mental illness. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Mental illness and substance use illnesses are the most common cause of disease burden in the United States. Over half of individuals with mental illness do not receive appropriate care for their illnesses. This often results in poor outcomes like early mortality, more hospitalizations and increased use of emergency departments (EDs). Provider and payor systems have embarked on delivery system reforms that aim to improve quality of care and reduce health disparities for these individuals. In this dissertation we examine three aspects of health care quality – readmission, ED use and continuity of care – to explore their impact for individuals with mental illness. We show that individuals with mental illness have greater odds of thirty day readmission after acute hospitalization and this odds is increased if medications are dropped after discharge. We categorize individuals with mental illness who frequent the ED and show that high utilizers have a significantly greater rate of substance use comorbidities than occasional utilizers. We also show that high utilizers do not use outpatient services concomitant with their ED use. Finally, we examine the care coordination in physical and behavioral health specialties for seriously mentally ill individuals who have type II diabetes and its association with ED use. We show that increased care coordination in physical health settings is associated with a lower rate of ED visits.
Public Health Significance
We expect our study to inform health care facilities and policy makers in developing health care delivery systems and improve quality of care for individuals with mental illness.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Gopalan, Kalyanikag117@pitt.edukag117
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDonohue, Juliejdonohue@pitt.edu
Committee MemberHorvitz Lennon, Marcelamhorvitz@rand.org
Committee MemberGhinassi, Frankghinassi@ubhc.rutgers.edu
Committee MemberCastle, Nicholascastlen@pitt.edu
Committee MemberChang, Chung Chouchangj@pitt.edu
Date: 29 June 2017
Date Type: Publication
Defense Date: 5 April 2017
Approval Date: 29 June 2017
Submission Date: 28 April 2017
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 91
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Health Policy & Management
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Mental health, Medicaid, Medicare, Health Services Research, Group Based Trajectory, Emergency Department, Care Coordination, Readmission
Date Deposited: 29 Jun 2017 23:41
Last Modified: 01 Jul 2018 05:15
URI: http://d-scholarship.pitt.edu/id/eprint/31645

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