Family Involvement Associated With Better Postdischarge Outcomes in Psychiatric Patients

Family involvement, especially communication with inpatient staff, was associated with more comprehensive postdischarge planning and prompt entry into outpatient care, according to study results published in Psychiatry Services.

Investigators conducted a retrospective study of patients with a psychiatric hospitalization at two participating hospitals in New York state between 2012 and 2013. Demographic data and clinical characteristics were abstracted from Medicaid claims data and closed medical records. Investigators defined family as any relative, significant other, or friend of a patient; paid supporters such as parole officers and case managers were excluded. Support from family members was defined as any family-patient or family-staff interaction noted in the medical records. Investigators then determined whether patients had a comprehensive discharge plan, defined as completion of the following three tasks by inpatient staff: communicating with outpatient provider, scheduling an outpatient appointment with said provider, and forwarding a discharge summary to the outpatient provider. In addition, investigators captured patient attendance of an outpatient mental health appointment within 7 and 30 days of discharge. Logistic regression was performed to determine the influence of family involvement on patient outcomes. 

The final analytic sample comprised 179 unique discharges across hospitals. Inpatient staff contacted a family member for 134 of these patients (75%). Of the patients, 67 (37%) received comprehensive discharge planning, and 96 (54%) and 139 (78%) attended a follow-up appointment within 7 and 30 days of discharge, respectively.  Family phone calls and/or visits with patients (odds ratio [OR], 2.39), attendance at family therapy sessions (OR, 2.74), and communication with inpatient staff about family services (OR, 2.25) were associated with comprehensive discharge planning. Inpatient staff contacting family (average OR, 2.57), communicating about the patient’s health and/or mental health (average OR, 2.56), and communicating about the discharge plan (average OR, 2.21), were significantly associated with attendance of a follow-up mental health appointment within 7 or 30 days after discharge.  

Patients younger than 21 years were more likely to have family involvement, while shorter hospital stays (0 to 6 days) and co-occurring substance use disorder predicted less family involvement. When controlled for demographic and clinical factors, any involvement between family and inpatient staff was the strongest predictor for patient attendance of a mental health appointment within 7 (OR, 2.79; 95% CI, 1.28-6.08) and 30 days (OR, 3.07; 95% CI, 1.29-7.32) of discharge (both P <.01).

These data underscore the positive impact of family involvement on post-discharge patient outcomes. Even so, family were contacted in just 75% of cases; further research should investigate effective means to increase family involvement in psychiatric care. Researchers noted that alternatives should be considered for individuals without family, or if it there is a need to limit contact with family members.

“Attempting to contact and involve a family member should be part of standard care for mental health inpatients,” researchers concluded.

Reference

Haselden M, Corbeil T, Tang F, et al. Family involvement in psychiatric hospitalizations: associations with discharge planning and prompt follow-up care [published online July 16, 2019]. Psychiatr Serv. doi:10.1176/appi.ps.201900028