The journal of mental health administration

, Volume 21, Issue 3, pp 298–312 | Cite as

Development of clinical methods for utilization review in psychiatric day treatment

  • Kenneth G. Terkelsen
  • Richard H. McCarthy
  • Richard L. Munich
  • Barbara E. Hurley
Regular Articles


When a time-limited day treatment program was reconfigured to serve individuals with long-standing psychotic disorders, the number of treatment episodes exceeding six months rose to 70%. To justify this concentration of resources, the program needed methods to identify individuals for whom sustained treatment was appropriate. This report describes development of utilization review methods adapted to publicly funded day treatment of individuals with serious mental illness and training of clinicians in new documentation skills. Data from three years of operation suggest that symptom severity is not a reliable indicator of medical necessity in day treatment. As expected with a clinically based system, a composite measure of benefit and medical necessity indicators weighted toward functioning in living, learning, working, and socializing environments predicted physician reviewer denial of continued day treatment, but length of stay did not.


Schizophrenia Physician Review Psychotic Disorder Community Psychiatry Utilization Review 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Payne S: How to set up a focused utilization review effort.Business Health 1987; 5(1):32–34, 36.PubMedGoogle Scholar
  2. 2.
    Fox P, Goldbeck W, Spies F:Health Care Cost Management. Ann Arbor, MI: Health Administration Press, 1984.Google Scholar
  3. 3.
    Sederer LI: Utilization review and quality assurance: Staying in the black and working with the blues.General Hospital Psychiatry 1987; 9(3):210–219.PubMedCrossRefGoogle Scholar
  4. 4.
    Grogan CM: Deciding on access and levels of care: A comparison of Canada, Britain, Germany, and the United States.Journal of Health Politics, Policy and Law 1992; 17(2):213–231.PubMedGoogle Scholar
  5. 5.
    National Association of Private Psychiatric Hospitals.Surveys on the Impact of Psychiatric Case Management and Managed Care. Washington, DC: Author, 1988.Google Scholar
  6. 6.
    Glazer WM, Kramer R, Montgomery JS, et al.: Use of medical necessity scales in concurrent review of psychiatric inpatient care.Hospital and Community Psychiatry 1991; 42(12):1199–1200.PubMedGoogle Scholar
  7. 7.
    Hodgkin D: The impact of private utilization management on psychiatric care: A review of the literature.Journal of Mental Health Administration 1992; 19(2):143–157.PubMedGoogle Scholar
  8. 8.
    National Association of Private Hospital Systems: 1992 NAPHS Annual Survey. National Association of Private Hospital Systems Annual Meeting, Fort Lauderdale, FL, January 27, 1993.Google Scholar
  9. 9.
    Rodriguez AR: Evolutions in utilization and quality management: A crisis for psychiatric services?.General Hospital Psychiatry 1989; 11(4):256–263.PubMedCrossRefGoogle Scholar
  10. 10.
    Culhane DP, Hadley TR: A re-examination of the reported decline in partial hospitalization.Journal of Mental Health Administration 1993; 20(2):153–160.PubMedGoogle Scholar
  11. 11.
    Test MA, Stein LI: Alternative to mental hospital treatment, III: Social cost.Archives of General Psychiatry 1980; 37(4):409–412.PubMedGoogle Scholar
  12. 12.
    Torrey EF: Continuous treatment teams in the care of the chronic mentally ill.Hospital and Community Psychiatry 1986; 37(12):1243–1247.PubMedGoogle Scholar
  13. 13.
    Borland A, McRae J, Lycan C: Outcomes of five years of continuous intensive case management.Hospital and Community Psychiatry 1989; 40(4):369–376.PubMedGoogle Scholar
  14. 14.
    Stein LI, Test MA: Alternative to mental hospital treatment, I: Conceptual model, treatment program, and clinical evaluation.Archives of General Psychiatry 1980; 37(4):392–397.PubMedGoogle Scholar
  15. 15.
    Arana JD, Hastings B, Herron E: Continuous care teams in intensive outpatient treatment of chronic mentally ill patients.Hospital and Community Psychiatry 1991; 42(5):503–507.PubMedGoogle Scholar
  16. 16.
    Siegel C, Laska E, Griffis A, et al.: Quantitative care norms for a psychiatric ambulatory population in a county medical assistance program.American Journal of Public Health 1978; 68(4):352–358.PubMedCrossRefGoogle Scholar
  17. 17.
    Dorney DC: Setting resource utilization standards in a community mental health center.QRB/Quality Review Bulletin 1982; 8(11):14–21.Google Scholar
  18. 18.
    Shepherd GL: Formats for peer review of dynamic psychotherapy.Hospital and Community Psychiatry 1985; 36(5):517–520.PubMedGoogle Scholar
  19. 19.
    Miller SI, Phillips KL: Chemical dependency disorders: Guidelines for review of inpatient therapy and rehabilitation. In: Mattson MR, Wilson GF (Eds.):Manual of Psychiatric Quality Assurance. Washington, DC: American Psychiatric Association, 1992, pp. 161–166.Google Scholar
  20. 20.
    Anthony W, Cohen M, Farkas M:Psychiatric Rehabilitation. Boston: Boston University Center for Psychiatric Rehabilitation, 1990.Google Scholar
  21. 21.
    Harding CM, Zubin J, Strauss JS: Chronicity in schizophrenia: Fact, partial fact or artifact?Hospital and Community Psychiatry 1987; 38(5):477–486.PubMedGoogle Scholar
  22. 22.
    Creed F, Anthony P, Godbert K, et al.: Treatment of severe psychiatric illness in a day hospital.British Journal of Psychiatry 1989; 154(3):341–347.PubMedGoogle Scholar
  23. 23.
    Tarrier N, Barrowclough C, Vaughn C, et al.: The community management of schizophrenia. A two-year follow-up of a behavioural intervention with families.British Journal of Psychiatry 1989; 154(5):625–628.PubMedCrossRefGoogle Scholar
  24. 24.
    Barton R.Institutional Neurosis, Bristol: John Wright, 1966.Google Scholar
  25. 25.
    Gruenberg EM: Objective appraisal of deterioration in a group of long-stay hospital patients.Milbank Memorial Fund Quarterly 1962; 40(1):90–100.PubMedCrossRefGoogle Scholar
  26. 26.
    Wells DA: Management of early postdischarge adjustment reactions following psychiatric hospitalization.Hospital and Community Psychiatry 1992; 43(10):1000–1004.PubMedGoogle Scholar
  27. 27.
    Wilson GF, Phillips KL: Utilization review criteria for adult extended hospitalization. In: Mattson MR, Wilson GF (Eds.):Manual of Psychiatric Quality Assurance. Washington, DC: American Psychiatric Association, 1992, pp. 121–126.Google Scholar
  28. 28.
    Appleby L, Desai PN, Luchins DJ, et al.: Length of stay and recidivism in schizophrenia: A study of public psychiatric hospital patients.American Journal of Psychiatry 1993; 150(1):72–76.PubMedGoogle Scholar
  29. 29.
    Gabbard GO: Comparative indications for brief and extended hospitalization. In: Tasman A, Riba MB (Eds.):Review of Psychiatry, Vol. 11. Washington, DC: American Psychiatric Press, 1992, chapter 25.Google Scholar
  30. 30.
    Reibel S, Herz MI: Limitations of brief hospital treatment.American Journal of Psychiatry 1976; 133(5):518–521.PubMedGoogle Scholar
  31. 31.
    Goldberg SC, Schooler NR, Hogarty GE, et al.: Prediction of relapse in schizophrenic outpatients treatment by drug and sociotherapy.Archives of General Psychiatry 1977; 34(2):171–184.PubMedGoogle Scholar
  32. 32.
    Meltzhoff J, Blumenthal RJ:The Day Treatment Center. Springfield, IL: Charles C Thomas, 1966.Google Scholar
  33. 33.
    Linn MW, Caffey EM, Klett CJ, et al.: Day treatment and psychotropic drugs in the aftercare of schizophrenic patients.Archives of General Psychiatry 1979; 36(10):1055–1066.PubMedGoogle Scholar
  34. 34.
    Gootnick I: The psychiatric day center in the treatment of the chronic schizophrenic.American Journal of Psychiatry 1971; 128(10):485–488.PubMedGoogle Scholar
  35. 35.
    Bleuler M:The Schizophrenic Disorders: Long-term Patient and Family Studies. New Haven, CT: Yale University Press, 1978.Google Scholar
  36. 36.
    Breier A, Strauss JS: Self-control in psychotic disorders.Archives of General Psychiatry 1983; 40(10):1141–1145.PubMedGoogle Scholar
  37. 37.
    Drake RE, Sederer LI: The adverse effects of intensive treatment of chronic schizophrenia,Comprehensive Psychiatry 1986; 27(4):313–326.PubMedCrossRefGoogle Scholar
  38. 38.
    Wells DA: Management of early postdischarge adjustment reactions following psychiatric hospitalization.Hospital and Community Psychiatry 1992; 43(10):1000–1004.PubMedGoogle Scholar
  39. 39.
    New York State Office of Mental Health.Statewide Comprehensive Plan for Mental Health Services, 1990–1995. Albany, NY: Author, 1989.Google Scholar
  40. 40.
    Bachrach LL: Overview: Principles of planning for chronic psychiatric patients: A synthesis. In: Talbott JA (Ed.):The Chronic Mental Patient: Five Years Later. Orlando, FL: Grune and Stratton, 1984, pp. 165–182.Google Scholar
  41. 41.
    Falloon IRH, Boyd Jl, McGill CW, et al.: Family management in the prevention of exacerbations of schizophrenia: A controlled study.New England Journal of Medicine 1982; 306(24):1437–1440.PubMedCrossRefGoogle Scholar
  42. 42.
    Anthony WA, Cohen MR, Cohen BF: The philosophy, treatment process and principles of the psychiatric rehabilitation approach.New Directions in Mental Health Services 1983; 17:67–79.Google Scholar
  43. 43.
    Carpenter WT, Heinrichs DW: Early intervention, time-limited, targeted pharmacotherapy of schizophrenia.Schizophrenia Bulletin 1983; 9(4):533–542.PubMedGoogle Scholar
  44. 44.
    Meyerson AT, Herman GS: What’s new in aftercare? A review of recent literature.Hospital and Community Psychiatry 1983; 34(4):333–342.PubMedGoogle Scholar
  45. 45.
    Cutler D: Networks. In: Talbott JA (Ed.):The Chronic Mental Patient: Five Years Later. Orlando, FL: Grune and Stratton, 1984, pp. 253–266.Google Scholar
  46. 46.
    Breier A, Strauss JS: The role of social relationships in the recovery from psychotic disorders.American Journal of Psychiatry 1984; 141(8):949–955.PubMedGoogle Scholar
  47. 47.
    Wilson GF: An evaluation of cost-control approaches to health care. In: Mattson MR, Wilson GF (Eds.):Manual of Psychiatric Quality Assurance. Washington, DC: American Psychiatric Association, 1992, pp. 3–6.Google Scholar
  48. 48.
    Kane J, Honigfeld G, Singer J, et al.: Clozapine for the treatment-resistant schizophrenic.Archives of General Psychiatry 1988; 45(9):789–796.PubMedGoogle Scholar
  49. 49.
    Anthony WA, Unger KV: Supported education: An additional program resource for young adults with long term mental illness.Community Mental Health Journal 1991; 27(2):145–156.PubMedCrossRefGoogle Scholar
  50. 50.
    Taube CA, Morlock L, Burns BJ, et al.: New directions in research on assertive community treatment.Hospital and Community Psychiatry 1990; 41(6):642–647.PubMedGoogle Scholar
  51. 51.
    Mosher LR, Feinsilver D:Special Report on Schizophrenia. Bethesda, MD: National Institute of Mental Health, 1971.Google Scholar
  52. 52.
    Gunderson JG, Mosher LR: The cost of schizophrenia.American Journal of Psychiatry 1975; 132(9): 901–906.PubMedGoogle Scholar
  53. 53.
    Eckman TA, Wirshing WC, Marder SR, et al.: Technique for training schizophrenic patients in illness self-management: A controlled trial.American Journal of Psychiatry 1992; 149(11):1549–1555.PubMedGoogle Scholar
  54. 54.
    Health Care Financing Administration: Medicare and Medicaid programs; OBRA’87 conforming amendments.Federal Register March 1, 1991; 56(41):8832–8854.Google Scholar
  55. 55.
    Wallace CJ, Nelson CJ, Liberman RP, et al.: A review and critique of social skills training with schizophrenic patients.Schizophrenia Bulletin 1980; 6(1):42–63.PubMedGoogle Scholar
  56. 56.
    Robey KL: Group home residents’ identities as patients and as community members.Hospital and Community Psychiatry 1994; 45(1):58–62.PubMedGoogle Scholar
  57. 57.
    Liberman RP (Ed.):Psychiatric Rehabilitation of Chronic Mental Patients. Washington, DC: American Psychiatric Press, 1988.Google Scholar
  58. 58.
    Byalin K: The quality assurance dilemma in psychiatry: A sociological perspective.Community Mental Health Journal 1992; 28(5):453–459.PubMedCrossRefGoogle Scholar
  59. 59.
    Zarin DA, Pincus HA, McIntyre JS: Practice guidelines. Editorial.American Journal of Psychiatry 1993; 150(2):175–177.PubMedGoogle Scholar
  60. 60.
    Lovejoy M: Expectations and the recovery process.Schizophrenia Bulletin 1982; 8(4):605–609.PubMedGoogle Scholar
  61. 61.
    Hogarty GE, Goldberg SC, Schooler NR, et al.: Drug and sociotherapy in the aftercare of schizophrenic patients. II. Two-year relapse rates.Archives of General Psychiatry 1974; 31:603–608.PubMedGoogle Scholar
  62. 62.
    Hogarty GE: Treatment and the course of schizophrenia.Schizophrenia Bulletin 1977; 3:587–599.PubMedGoogle Scholar
  63. 63.
    Task Force Report of the American Psychiatric Association: Effects of antipsychotic drugs: tardive dyskinesia.American Journal of Psychiatry 1980: 137:1163–1171.Google Scholar
  64. 64.
    Zwerling I: Community psychiatric treatment. In: Bellak L (Ed.):Disorders of the Schizophrenic Syndrome. New York: Basic Books, 1979, pp. 453–471.Google Scholar
  65. 65.
    Kane JM: Dosage reduction strategies in the long-term treatment of schizophrenia. In: Kane JM (Ed.):Drug Maintenance Strategies in Schizophrenia. Washington, DC: American Psychiatric Press, 1984, pp. 1–11.Google Scholar
  66. 66.
    Spilker B:Quality of Life Assessments in Clinical Trials. New York: Raven Press, 1990.Google Scholar
  67. 67.
    Lehman AF, Ward NC, Linn LS: Chronic mental patients: The quality of life issue.American Journal of Psychiatry 1982; 139(10):1271–1276.PubMedGoogle Scholar
  68. 68.
    Lehman AF: The well-being of chronic mental patients.Archives of General Psychiatry 1983; 40(4):369–373.PubMedGoogle Scholar
  69. 69.
    Dobmeyer TW, McKee PA, Miller RD, et al.: The effect of enrollment in a prepaid health plan on utilization of a community crisis intervention center by chronically mentally ill individuals.Community Mental Health Journal 1990; 26(2):129–137.PubMedCrossRefGoogle Scholar
  70. 70.
    Christianson JB, Linehan MS: Capitated payments for mental health care: The Rhode Island programs.Community Mental Health Journal 1989; 25(2):121–131.PubMedCrossRefGoogle Scholar
  71. 71.
    Rothbard AB, Hadley TR, Schinnar AP, et al.: Philadelphia’s capitation plan for mental health services.Hospital and Community Psychiatry 1989; 40(4):356–358.PubMedGoogle Scholar
  72. 72.
    Babigian H, Marshall P: Rochester: A comprehensive capitation experiment.New Directions for Mental Health Services 1989; 43:43–54.PubMedGoogle Scholar

Copyright information

© Association of Mental Health Administrators 1994

Authors and Affiliations

  • Kenneth G. Terkelsen
    • 1
  • Richard H. McCarthy
    • 1
  • Richard L. Munich
    • 1
  • Barbara E. Hurley
    • 2
  1. 1.Department of PsychiatryCornell University Medical College and the New York Hospital, Westchester DivisionWhite Plains
  2. 2.Extended Treatment Services Division of the New York Hospital’s Westchester DivisionNew YorkUSA

Personalised recommendations