Psychiatr Serv 56:427-433, April 2005
© 2005 American Psychiatric Association
Special Section on the GAF: Continuity of Care and Clinical Outcomes in a National Health System
Greg A. Greenberg, Ph.D. and
Robert A. Rosenheck, M.D.
OBJECTIVE: Continuity of care is widely viewed as a key quality indicator for outpatient mental health care. However, few studies have been conducted of the relationship between continuity of care and client outcomes. This study examined the relationship between measures of three aspects of continuity of care (regularity of care, continuity of treatment across organizational boundaries, and intensity of treatment) and the Global Assessment of Functioning (GAF), a single-item mental health status measure, in a national health care system. METHODS: Three analytic samples were derived from a nationwide Department of Veterans Affairs administrative data set: patients with at least one inpatient GAF rating and a later outpatient GAF rating (N=8,334) and two groups who had at least two outpatient GAF ratings, one group that was beginning a new episode of treatment (N=49,946) and a second group in ongoing treatment (N=123,371). Hierarchical linear modeling was used to control for potential site-level autocorrelation and to adjust for differences in diagnostic status, sociodemographic characteristics, baseline GAF score, and the length of time between GAF ratings. RESULTS: Several positive and significant relationships were found for discharged inpatients and new outpatients. However, only a few of these relationships could be confidently said to be clinically meaningful. Specifically, among discharged inpatients, for every additional month in which an outpatient visit occurred over a six-month period, there was a .69 increase in the GAF change score for a total increase of 4.1 points. Among new outpatients the equivalent values were smaller, at .3 and 1.8. In contrast with the findings for discharged inpatients and new outpatients, high intensity of care was negatively associated with GAF change scores for continuing outpatients. CONCLUSIONS: In contrast with several earlier studies, this study showed positive and statistically significant associations between several continuity-of-care measures and client outcomes. These relationships were observed only in transitional treatment situations, that is, after hospital discharge and at the beginning an episode of outpatient care, situations in which continuity of care may be especially important. However, although positive and statistically significant, the magnitude of these effects may not have been clinically meaningful.
Related Article:
-
April 2005: This Month's Highlights
Psychiatr Serv 2005 56: 395.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
N. Niv, A. N. Cohen, G. Sullivan, and A. S. Young
The MIRECC Version of the Global Assessment of Functioning Scale: Reliability and Validity
Psychiatr Serv,
April 1, 2007;
58(4):
529 - 535.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. P. Slade, D. S. Salkever, R. Rosenheck, J. Swanson, M. Swartz, D. Shern, G. Gallucci, C. Harding, L. Palmer, and P. Russo
Cost-Sharing Requirements and Access to Mental Health Care Among Medicare Enrollees With Schizophrenia
Psychiatr Serv,
August 1, 2005;
56(8):
960 - 966.
[Abstract]
[Full Text]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 2005
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
