A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

Meyer, Piper S.; Morrissey, J

doi:10.1176/ps.2007.58.1.121

Cited by 32 publications

(14 citation statements)

References 57 publications

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“…The results of this study are consistent with previous studies suggesting that ICM can be highly effective when delivered to members with serious and persistent mental illness at high risk of hospitalization (Cook et al, 2008;Meyer & Morrissey, 2007;Rosen et al, 2008). Cost-effective ICM services should routinely be provided to adults with chronic psychiatric conditions and a history of repeated hospitalizations.…”

Section: Discussionsupporting

confidence: 89%

“…Burns and colleagues (2007) cite the failure to control for previous hospital utilization as the main reason for the inconsistency, as ICM appears most effective at reducing hospitalized days among patients with a history of repeated hospitalizations or known to be at high risk of hospitalization (Burns et al, 2000;Mueser, Bond, Drake, & Resnick, 1998;Prince, 2006;Rosen, Bond, & Teesson, 2008;Tyrer, 2000a). ICM is more effective in settings with an ample supply of treatment and support services such as managed care environments (Meyer & Morrissey, 2007). Other possible reasons for the lack of outcome consistency include varying health care contexts, with ICM more effective in countries without global health care coverage (Burns et al, 2007;Burns, Fioritti, Holloway, Malm, & Rossler, 2001).…”

mentioning

confidence: 99%

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Reducing Six-Month Inpatient Psychiatric Recidivism and Costs Through Case Management

Kolbasovsky¹,

Reich²,

Meyerkopf³

2010

Care Management Journals

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The objective of this study is to determine the reduction in inpatient psychiatric recidivism and costs associated with an intensive case management (ICM) program among high-risk adults with chronic mental health conditions. An intent-to-treat, historical control design was used to examine utilization differences between 306 intervention group (IG) members eligible to receive ICM services and a cohort of 290 baseline group (BG) members over a six-month outcome period. Members were identified retrospectively using identical criteria during one year prior to implementation of the program. The six-month recidivism rate for BG members was 49.67% compared to 22.07% among IG members. Forward stepwise regression results indicated a significant main effect for the ICM intervention on inpatient psychiatric costs. Inpatient psychiatric costs for the six-month outcome period were $4,982.90 lower per member in the IG group. Additional models demonstrated that the ICM intervention was associated with significantly lower inpatient substance abuse costs and psychiatric emergency department costs. There were no statistically significant increases in utilization associated with the ICM intervention. After factoring in program costs, it is estimated that the ICM services contributed to almost $1,500,000 in cost savings over the six-month outcome period. The ICM intervention was associated with significant reductions in inpatient, psychiatric six-month readmission rates and associated costs among adult members who are at elevated risk of inpatient, psychiatric recidivism. The intervention, enrollment process, and measurement strategies can be adapted for use by health plans looking to reduce psychiatric costs.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Reducing Six-Month Inpatient Psychiatric Recidivism and Costs Through Case Management

Kolbasovsky¹,

Reich²,

Meyerkopf³

2010

Care Management Journals

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“…Another Dutch study found a (negative) relationship between level of ACT model fidelity, especially team structure, and some items of the HoNOS and the number of homeless days (Van Vugt et al 2011). Implementation of fully fledged ACT is especially difficult in rural areas because of the low population density, the lack of adequate services for patients and the lack of personnel (Meyer and Morrissey 2007). This was one of the reasons for the development in the Netherlands of the FLEXIBLE ACT model (Van Veldhuizen 2007; Van Veldhuizen et al 2008; Van Veldhuizen and Bähler 2013).…”

Section: Introduction: Act and Flexible Actmentioning

confidence: 99%

Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study

Nugter

Engelsbel

Bähler

et al. 2015

Community Ment Health J

107

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This study aimed to investigate social and clinical outcomes and use of care during and after implementation of FLEXIBLE Assertive Community Treatment (ACT). Three teams and 372 patients were involved. Model fidelity, clinical and social assessments were performed at baseline and after 1 and 2 years. Use of care was registered continuously. Model fidelity was good at the end of the study. Data showed much variation between patients in number and duration of ACT periods. Statistically significant improvements were found in compliance, unmet needs and quality of life. Improvement of quality of life and functioning was related to duration of ACT. The percentage of remissions increased with 9 %. The number of admissions, admission days and face to face contacts differed between ACT and non-ACT patients, but generally decreased. Findings suggest that implementation of FACT results in a more flexible adaptation of care to the needs of the patients.

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“…The issues faced in Ontario, such as drift in target population, inadequate funding levels, workforce shortages in rural areas, and lack of ongoing system-wide monitoring, are consistent with those of other jurisdictions. 18,38 We would argue that it is necessary to attend to issues of leadership, funding, standards, oversight capacity, implementation support, and ongoing feedback on practice regardless of the system in which ACT teams are situated.…”

Section: Implications For Behavioral Healthmentioning

confidence: 99%

System-Wide Implementation of ACT in Ontario: An Ongoing Improvement Effort

George¹,

Durbin

Koegl

2008

J Behav Health Serv Res

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In the late 1990s, the government of Ontario undertook a province-wide implementation of Assertive Community Treatment (ACT). Capacity grew to 59 teams within 6 years. This paper describes the implementation process, focusing on three phases--start-up, or the enabling phase; feedback, or the reinforcement phase; and response, or the corrective action phase. Key implementation supports include an active oversight committee with representation from both the ministry and the field and the availability of the planning data on ACT performance. Three areas of underperformance were identified: lower than expected team caseloads, drift from the target client group, and significant under-staffing in the teams. Likely causes were suggested, and corrective actions developed, which centered on clarifying the ACT standards, especially related to intake criteria, rate of intake and staffing, increasing team funding, and establishing expectations for reporting and accountability. While these corrective responses are promising, implementation of infrastructure and mechanisms for providing systematic practice feedback is still underdeveloped.

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A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

Cited by 32 publications

References 57 publications

Reducing Six-Month Inpatient Psychiatric Recidivism and Costs Through Case Management

Reducing Six-Month Inpatient Psychiatric Recidivism and Costs Through Case Management

Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study

System-Wide Implementation of ACT in Ontario: An Ongoing Improvement Effort

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