• Ranak Trivedi, Philip Sylling, Edward P Post, Edwin S Wong, Alaina M Mori, Stephan D Fihn, and Karin Nelson.
• Dr. Trivedi is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. She is also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California. Mr. Sylling, Dr. Wong, Ms. Mori, and Dr. Nelson are with the Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle. Dr. Wong and Dr. Nelson are also with the University of Washington, Seattle, where Dr. Wong is with the Department of Health Services and Dr. Nelson, along with Dr. Fihn, is with the Department of General Internal Medicine. Dr. Post is with the Center for Clinical Management Research, VA Ann Arbor Health Care System and the Department of Internal Medicine, University of Michigan, Ann Arbor.
• Psychiatr Serv. 2018 Dec 1; 69 (12): 1252-1258.

ObjectivesThe authors examined whether the rate of preventable hospitalizations among veterans with mental illness changed after implementation of the Department of Veterans Affairs (VA) primary care medical home-Patient Aligned Care Teams (PACT).MethodsA 12-year retrospective cohort analysis was conducted of data from 9,206,017 veterans seen in 942 VA primary care clinics between October 2003 and March 2015. Preventable hospitalizations were those related to ambulatory care-sensitive conditions (ACSCs), identified with ICD-9 codes. Changes in rates of ACSC-related hospitalizations were compared between patients with and without mental illness in two age groups (<65, ≥65). Patients with mental illness diagnoses were grouped as follows: depression, posttraumatic stress disorder, anxiety, substance use disorder, and serious mental illness. Interrupted time-series analysis was used to model long-term trends and detect deviations after PACT implementation.ResultsThere was an overall increase in mental illness diagnoses across both age groups. Among older veterans (≥65) with any mental illness, the rate (per 1,000 patients) of ACSC-related hospitalizations was five fewer in the post-PACT period, compared with the pre-PACT period. Among younger veterans (<65), there was a slight increase in ACSC-related hospitalizations in years 3-5 post-PACT if they had any mental illness (.6 per 1,000 patients), depression (.3), anxiety (1.4), or a substance use disorder (.6).ConclusionsIn this retrospective, observational study examining large systemwide changes in clinical practice, mental illness was more likely to be diagnosed after PACT implementation, compared with before, and results suggested a benefit of PACT implementation among older veterans in terms of a reduction in ACSC-related hospitalizations.

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