Skip to main content
Log in

Impact of travel distance on the disposition of patients presenting for emergency psychiatric care

  • Brief Reports
  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

For veterans presenting for emergency psychiatric care, this research tested the hypothesis that patients with poor geographic accessibility to ambulatory mental health services would be more likely to be hospitalized. Logistic regression results indicated that distant patients (>60 miles) were 4.8 times more likely (p<.05) to be admitted for acute psychiatric treatment than were proximal patients (<60 miles), controlling for clinical and demographic case-mix factors. This finding suggests that the Department of Veterans Affairs might be less effective in its effort to substitute intensive out-patient care in place of expensive inpatient treatment for rural veterans with emergent mental health problems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Kizer K:Vision for Change: A Plan to Restructure the Veterans Health Administration. VHA field reorganization—Report to Congress, Title 38 U.S.C. 510(b). Washington, DC: Government Printing Office, 1995.

    Google Scholar 

  2. Fortney J, Lancaster AE, Owen R, et al.: Geographic market areas for psychiatric and medical outpatient treatment.Journal of Behavioral Health Services & Research 1998; 25:108–116.

    Google Scholar 

  3. Fortney J, Booth B, Blow F, et al.: The effects of travel barriers and age on the utilization of alcoholism treatment aftercare.American Journal of Drug and Alcohol Abuse 1995; 21:391–406.

    Google Scholar 

  4. Institute of Medicine:Broadening the Base of Treatment for Alcohol Problems. Report of a study by a committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine. Washington, DC: National Academy Press, 1990.

    Google Scholar 

  5. Spitzer R, Gibbon M, Williams J, et al.: Global Assessment of Functioning (GAF) scale. In: Sederer L, Dickey B (Eds.):Outcomes Assessment in Clinical Practice. Baltimore, MD: Williams & Wilkins, 1996, pp. 76–78.

    Google Scholar 

  6. Jones S, Thornicroft G, Coffey M, et al.: A brief mental health outcome scale: Reliability and validity of the Global Assessment of Functioning (GAF).British Journal of Psychiatry 1995; 166:654–659.

    Google Scholar 

  7. Bodlund O, Kullgren G, Ekselius L, et al.: Axis V: Global Assessment of Functioning scale—Evaluation of a self-report version.Acta Psychiatrica Scandinavica 1994; 90:342–347.

    Google Scholar 

  8. Goldman J, Skodol A, Lave T: Revising Axis V for DSM-IV: A review of measures of social functioning.American Journal of Psychiatry 1993; 150:910–915.

    Google Scholar 

  9. Lyness J, Caine E, Conwell Y, et al.: Depressive symptoms, medical illness and functional status in depressed psychiatric inpatients.American Journal of Psychiatry 1993; 150:910–915.

    Google Scholar 

  10. Rabinowitz J, Modai I, Inbar-Saban N: Understanding who improves after psychiatric hospitalization.Acta Psychiatrica Scandanavica 1994; 89:152–158.

    Google Scholar 

  11. Kunik M, Ponce H, Molinar V, et al.: The benefits of psychiatric hospitalization for older nursing home residents.Journal of the American Geriatrics Society 1996; 44:1062–1065.

    Google Scholar 

  12. Booth B, Ludke R, Wakefield D, et al.: Nonacute inpatient admissions to Department of Veterans Affairs Medical Centers.Medical Care 1991; 29(8):AS40-AS50.

    Google Scholar 

  13. Booth B, Ludke R, Wakefield D, et al.: Relationship between inappropriate admissions and days of care: Implications for utilization management.Hospital and Health Services Administration 1991; 36:421–437.

    Google Scholar 

  14. Booth BM, Ludke RL, Wakefield DS, et al.: Nonacute days of care within Department of Veterans Affairs Medical Centers.Medical Care 1991; 29(8):AS51-AS63.

    Google Scholar 

  15. Ludke R, Booth B, Lewis-Beck J: Relationship between early readmission and hospital quality of care indicators.Inquiry 1993;30:95–103.

    Google Scholar 

  16. Smith C, Goldman R, Martin D, et al.: Overutilization of acute-care beds in Veterans Affairs hospitals.Medical Care 1996; 34(1):85–96.

    Google Scholar 

  17. Piette J, Moos R: The influence of distance on ambulatory care use, death, and readmission following a myocardial infarction.Health Services Research 1996; 37:573–591.

    Google Scholar 

  18. Holloway J, Medendorp S, Bromberg J: Risk factors for early readmission among veterans.Health Services Research 1990; 25:213–237.

    Google Scholar 

  19. Wheeler S, Phibbs C, Piette J: The Influence of Distance on Utilization of Outpatient Mental Health Aftercare following Inpatient Substance Abuse Treatment. Unpublished manuscript, HSR&D Center for Health Care Evaluation, Veterans Affairs Medical Center, Palo Alto, CA, 1998.

    Google Scholar 

  20. Burgess J, DeFiore D: The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services.Social Science and Medicine 1994; 39:95–104.

    Google Scholar 

  21. General Accounting Office:VA Health Care: How Distance from VA Facilities Affects Veterans' Use of VA Services. Letter report (HEHS-96-31). Washington, DC: Government Printing Office, 1995.

    Google Scholar 

  22. Dove H, Schneider K: The usefulness of patients' individual characteristics in predicting no-shows in outpatient clinics.Medical Care 1981; 19:734–740.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John C. Fortney Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fortney, J.C., Owen, R. & Clothier, J. Impact of travel distance on the disposition of patients presenting for emergency psychiatric care. The Journal of Behavioral Health Services & Research 26, 104–108 (1999). https://doi.org/10.1007/BF02287798

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02287798

Keywords

Navigation