Factors associated with follow-up care following child/adolescent psychiatric hospitalization
Emily Hamovitch, a PhD candidate at the Institute of Health Policy, Management and Evaluation, and a Leong Scholar, is examining follow-up care for children and adolescents discharged from hospitalization with a diagnosis of anxiety, depression, or self-harm. Follow-up care for this population is essential to supporting recovery, and reducing risk of readmission. However, in Ontario, access to post-discharge care remains inconsistent and inequitable.
My thesis explores this challenge through four interconnected studies. First, I am examining whether Ontario’s virtual care billing policies have influenced rates of timely follow-up care, including whether impacts differ by rurality, socioeconomic context, age, and sex. Second, I am investigating which patient- and hospital-level characteristics are associated with receiving follow-up care within seven days of discharge. Third, I am analyzing variation in follow-up care rates across Ontario hospitals and municipalities to better understand where gaps exist. Finally, through interviews with healthcare providers and administrators, I am exploring how hospitals organize follow-up care, and the barriers and facilitators they face in ensuring continuity of care.
Using provincial health administrative data and qualitative interviews, my work is generating much-needed evidence on patient-level and system-level barriers to care. I have completed the hospital variation analysis and found wide variation in follow-up care rates across hospitals, highlighting the need for targeted efforts to strengthen hospital- and community- level practices that facilitate timely follow-up care. I am currently conducting and interpreting the patient- and hospital-level predictors analyses, using advanced analytical approaches to examine how demographic, clinical, service use, and hospital-level factors are associated with timely follow-up care within seven days of discharge, with additional sensitivity analyses extending this window to 30 days.
On the qualitative side, I have conducted, transcribed, and coded 18 interviews with clinical and administrative staff across six hospitals in Ontario. I am now in the final stages of qualitative analysis, synthesizing findings into broader themes and preparing results for dissemination.
My research is supported by several awards, including a CIHR doctoral award and a Leong Centre Studentship Award. The findings from this work will have relevance to clinicians working with children and adolescents, to hospital administrators who are concerned with benchmarks and standards of care, and to policy makers and health system planners who use evidence to establish guidelines for optimal care.
