Evaluating and Comparing Approaches to Measuring Quality of Postdischarge Mental Health Outpatient Follow-Up Care

OBJECTIVE: This study aimed to evaluate whether measures of follow-up mental health and substance use care (behavioral health) within 30 days provide signals of quality associated with longer-term positive outcomes and whether a national U.S. Department of Veterans Affairs (VA) postdischarge follow-up and engagement (PDE) measure with more rigorous follow-up requirements is associated with additional benefit. METHODS: This retrospective study used VA administrative records for 115,723 unique veteran discharges from inpatient or residential behavioral health treatment between October 2016 and February 2019, with discharges categorized by level of 30-day behavioral health postdischarge outpatient follow-up: zero visits, one visit, more than one visit, and two to four visits or more (met VA PDE). Propensity score-weighted models tested associations between follow-up intensity and number of 6-month outpatient behavioral health visits, 6-month primary care engagement, and 1-year all-cause mortality. RESULTS: Patients meeting the VA PDE measure had significantly better longer-term outcomes than those who received one or fewer visits within 30 days. Discharges meeting VA PDE were associated with the greatest increases in subsequent behavioral health visits (3.43 times increase in visits compared with zero visits within 30 days), higher likelihood of primary care contact (OR=2.12), and greater reductions in all-cause mortality (OR=0.71). CONCLUSIONS: Greater engagement in 30-day postdischarge behavioral health follow-up is associated with greater outpatient behavioral health engagement, higher likelihood of receiving primary care, and lower 1-year all-cause mortality. These findings support resource allocation toward postdischarge care coordination and broadly adopting more stringent quality standards.