The objective of this study was to determine the cost and effectiveness of a transitional discharge model (TDM) of care with clients who have a chronic mental illness. The model was tested in a randomized clinical trial using a cluster design. This model consisted of: (1) Peer support for 1 year and (2) Ongoing support from hospital staff until a therapeutic relationship was established with the community care provider. Participants (n = 390) were interviewed at discharge, 1 month post-discharge, 6 months post-discharge and 1 year post-discharge. Data collected included demographics, quality of life, health care utilization, levels of functioning and the degree of intervention received. The intervention group post-discharge costs and quality of life were not significantly improved compared with the control group. Although not predicted a priori, intervention subjects were discharged an average of 116 days earlier per person. Based on the hospital per diem rate this would be equivalent to 12M dollars CDN hospital costs. Both under-implementation among implementation wards and contamination in control wards were found. This study demonstrates some of the multiple challenges in health system research.

<p>Effective discharge planning is needed to facilitate clients&rsquo; transition from psychiatric hospital wards to community care. Previous studies have shown that client outcomes can be improved by using a Transitional Discharge Model (TDM) that includes peer support and an extension of inpatient-practitioner relationships that are introduced prior to discharge. However, countries vary in many ways that may affect implementation of the model. This article describes some of the similarities and differences related to introducing transitional discharge in two countries: Canada and Scotland. It is important to elucidate facilitators and challenges in implementing the TDM to identify and disseminate strategies to aid implementation. Implications for future implementation of the model are also discussed.</p> <p>Dr. Forchuk is Professor, Faculty of Health Sciences, University of Western Ontario, and Assistant Director/Scientist, Lawson Health Research Institute, London, Ontario, Canada; Dr. Reynolds is Reader in Nursing, Department of Health Studies, Turku University of Applied Sciences, Salo, Finland; Dr. Sharkey is Senior Lecturer, University of Stirling, Department of Nursing and Midwifery, Highland Campus, Inverness, Scotland, United Kingdom; Ms. Martin is Clinical Nurse Specialist and Associate Clinical Professor, St. Joseph&rsquo;s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada; and Dr. Jensen is Assistant Professor, School of Nursing, York University, Toronto, and Scientist, Lawson Health Research Institute, London, Ontario, Canada. </p> <p>The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.</p> <p>Address correspondence to Cheryl Forchuk, RN, PhD, Assistant Director/Scientist, Lawson Health Research Institute, LHSC-SSC NR201, 375 South Street, London, Ontario, Canada N6A 4G5; e-mail: <a href="mailto:cforchuk@uwo.ca">cforchuk@uwo.ca</a>.</p>