Community Mental Health Journal

, Volume 48, Issue 5, pp 598–603 | Cite as

Effectiveness of a High End Users Program for Persons with Psychiatric Disorders

  • Aileen B. Rothbard
  • Sumedha Chhatre
  • Cynthia Zubritsky
  • Karen Fortuna
  • Steven Dettwyler
  • Renata J. Henry
  • Melissa Smith
Brief Report

Abstract

To evaluate the effectiveness of an intensive system of case management for high end users of inpatient care in reducing psychiatric inpatient utilization. A pre-post study design with a contemporaneous comparison group was employed to determine the effects of a State designed intervention to reduce inpatient care for adults with a mental health disorder who had high utilization of inpatient psychiatric care between 2004 and 2007. Logit and negative binomial regression models were used to determine the likelihood, frequency and total days of inpatient utilization in the post period as a function of the intervention. Data from administrative reporting forms and Medicaid claims were used to construct inpatient utilization histories and characteristics of 176 patients. Patients in both groups had a significant reduction in mean inpatient days. However, being in the intervention program did not result in lower odds of being re-hospitalized or in fewer episodes during the study period.

Keywords

Psychiatric hospitalization High end users Inpatient psychiatric recidivism 

References

  1. Appleby, L., Desai, P. N., Luchins, D. J., Gibbons, R. D., & Hedeker, D. R. (1993). Length of stay and recidivism in schizophrenia: A study of public psychiatric hospitalization. American Journal of Psychiatry, 150, 72–76.PubMedGoogle Scholar
  2. Arana, J. D., Hastings, B., & Herron, E. (1991). Continuous care teams in intensive outpatient treatment of chronic mentally ill patients. Hospital & Community Psychiatry, 42(5), 503–506.Google Scholar
  3. Bezold, H. S., MacDowell, M., & Kunkel, M. (1996). Predicting psychiatric length of stay. Administration and Policy in Mental Health, 23, 407–423.CrossRefGoogle Scholar
  4. Carperter, M. D., Mulligan, J. C., Bader, I. A., & Meinzer, A. E. (1985). Multiple admissions to an urban psychiatric center: A comparative study. Hosp Comm Psychiatry, 36, 1305–1308.Google Scholar
  5. Casper, E. S., & Donaldson, B. (1991). Subgroups in the population of frequent users of inpatient services. Hospital & Community Psychiatry, 41, 189–191.Google Scholar
  6. Casper, E. S., & Pastva, G. (1990). Admission histories, patterns, and subgroups of the heavy users of a state psychiatric hospital. Psychiatric Quarterly, 6l, 121–135.CrossRefGoogle Scholar
  7. Doering, S., Muller, E., Kopcke, W., Pietzcker, A., Gaebel, W., Linden, M., et al. (1998). Predictors of relapse and rehospitalization in schizophrenia and schizoaffective disorder. Schizophrenia Bulletin, 24, 87–98.PubMedCrossRefGoogle Scholar
  8. Frederick, S., Caldwell, K., & McGartland Rubio, D. (2002). Home-based treatment, rates of ambulatory follow-up, and psychiatric rehospitalization in a medicaid managed care population. The Journal of Behavioral Health Services & Research, 29, 466–475.CrossRefGoogle Scholar
  9. Green, J. H. (1988). Frequent rehospitalization and noncompliance with treatment. Hospital & Community Psychiatry, 39, 963–966.Google Scholar
  10. Hadley, T., Culhane, D. P., & McGurrin, M. C. (1992). Identifying and tracking “heavy users” of acute psychiatric inpatient services. Administration and Policy in Mental Health, 19, 279–290.CrossRefGoogle Scholar
  11. Hadley, T., McGurrin, M., Pulice, R., & Holohean, E. J. (1990). Using fiscal data to identify heavy service users. Psychiatric Quarterly, 61, 41–48.PubMedCrossRefGoogle Scholar
  12. Hansson, L. (2000). Inequality and inequity in use of mental health services. Acta Psychiatrica Scandinavica, 107, 161–162.CrossRefGoogle Scholar
  13. Harrison-Read, P., Lucas, B., Tyrer, P., Ray, J., Shipley, K., Simmonds, S., et al. (2002). Heavy users of acute psychiatric beds; randomized controlled trial of enhanced community management in an outer London borough. Psychological Medicine, 32, 403–416.PubMedCrossRefGoogle Scholar
  14. Havassy, B. E., & Hopkin, J. T. (1989). Factors predicting utilization of acute psychiatric inpatient services by frequently hospitalized patients. Hospital & Community Psychiatry, 40(8), 820–823.Google Scholar
  15. Hendryx, M. S., Russo, J. E., Stegner, B., Dyck, D. G., Ries, R. K., & Roy-Byrne, P. (2003). Predicting rehospitalization and outpatient services from administration and clinical databases. The Journal of Behavioral Health Services and Research, 30, 342–351.CrossRefGoogle Scholar
  16. Herren, O., Dixon, L., Gavirneni, S., & Regenold, W. T. (2002). The association between decreasing length of stay and readmission rate on a psychogeriatric unit. Psychiatric Services, 53, 76–79.CrossRefGoogle Scholar
  17. Holohean, E., Pulice, R., & Donahue, S. (1991). Utilization of acute inpatient psychiatric services: “Heavy users” in New York State. Administration and Policy In Mental Health, 18, 173–181.CrossRefGoogle Scholar
  18. Hudson, C. G. (2001). Changing patterns of acute psychiatric hospitalization under a public managed care program. Journal of Sociology and Social Welfare, 28, 141–176.Google Scholar
  19. Junghan, U., & Brenner, H. (2006). Heavy use of acute in-patient psychiatric services: The challenge to translate a utilization pattern into service provision. Acta Psychiatrica Scandinavica Supplement, 429, 24–32.CrossRefGoogle Scholar
  20. Lucas B., Harrison-Read P, Tyrer, P., Ray, J., Shipley, K., & Hickman, M. et al. (2001). Costs and characteristics of heavy inpatient service users in outer London The International journal of social psychiatry 47(1), 63–74 (Spring) .Google Scholar
  21. Monnelly, E. P. (1997). Instability before discharge and previous psychiatric admissions as predictors of early readmission. Psychiatric Services, 48, 1584–1586.PubMedGoogle Scholar
  22. Moran, P. W., Doerfler, L. A., Scherz, J., & Lish, J. D. (2000). Rehospitalization of psychiatric patients in a managed care environment. Mental Health Services Research, 2, 191–199.CrossRefGoogle Scholar
  23. Mortensen, P. B., & Eaton, W. W. (1994). Predictors for readmission risk in schizophrenia. Psychological Medicine, 24, 223–232.PubMedCrossRefGoogle Scholar
  24. Mullahy, J. (1986). Specifications and testing of some modified count data models. Journal of Econometrics, 33, 341–365.CrossRefGoogle Scholar
  25. Quinlivan, R., Hough, R., Crowell, A., Beach, C., Hofstetter, R., & Kenworhy, K. (1995). Service Utilization and costs of care for severely mentally ill clients in an intensive case management program. Psychiatric Services, 46, 365–371.PubMedGoogle Scholar
  26. Roick, C., Heider, D., Kilian, R., Matschinger, H., Toumi, M., & Angermeyer, M. (2004). Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology, 39, 744–751.PubMedCrossRefGoogle Scholar
  27. Rothbard, A., Lee, S., Noll, E & Hadley, T. (2009). Trends in psychiatric recidivism rates in acute care hospitals in Pennsylvania. Policy brief # 4, University of Pennsylvania Center for Mental Health policy and Services Research.Google Scholar
  28. Rothbard, A., Zubritsky, C, Chhatre, S, Henry, R, Smith, M. & Dettwyler, S. (2009). Building Evidence for the high-end user program at the delaware psychiatric center. Policy brief # 2, University of Pennsylvania Center for Mental Health policy and Services Research.Google Scholar
  29. Teenson, M., & Hambridge, J. (1992). Mobile community treatment in inner-city and suburban Sydney. Psychiatric Quarterly, 63, 119–127.CrossRefGoogle Scholar
  30. Vogel, S. & Huguelet, P. (1997). Factors associated with multiple admissions to a public psychiatric hospital. Acta Psychiatrica Scandinavica, 244–253.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Aileen B. Rothbard
    • 1
  • Sumedha Chhatre
    • 2
  • Cynthia Zubritsky
    • 3
  • Karen Fortuna
    • 4
  • Steven Dettwyler
    • 5
  • Renata J. Henry
    • 6
    • 7
  • Melissa Smith
    • 8
  1. 1.Center for Mental Health Policy and Service ResearchPhiladelphiaUSA
  2. 2.Center for Mental Health Policy and Service ResearchPhiladelphiaUSA
  3. 3.Center for Mental Health Policy and Service ResearchPhiladelphiaUSA
  4. 4.Center for Mental Health Policy and Service ResearchPhiladelphiaUSA
  5. 5.Mental Health ProgramsDSAMH/DHSSNew CastleUSA
  6. 6.Department of Health and Mental HygieneBaltimoreUSA
  7. 7.Department of Behavioral Health and DisabilitiesBaltimoreUSA
  8. 8.Division of Substance Abuse and Mental HealthDSAMH/DHSSNew CastleUSA

Personalised recommendations