Multisite Experimental Cost Study of Intensive Psychiatric Community Care

Abstract

A 2-year experimental cost study of 10 Intensive Psychiatric Community Care (IPCC) programs was conducted at Department of Veterans Affairs (VA) medical centers in the Northeast. High hospital users were randomly assigned to either IPCC (n = 454) or standard VA care (n = 419) at four neuropsychiatric (NP) and six general medical and surgical (GMS) hospitals. National computerized data were used to track all VA health care service usage and costs for 2 years following program entry. At 9 of the 10 sites, IPCC treatment resulted in reduced inpatient service usage. Overall, for IPCC patients compared with control patients, average inpatient usage was 89 days (33%) less while average cost per patient (for IPCC inpatient, and outpatient services) was $15,556 (20%) less. Additionally, costs for IPCC patients compared with control patients were $33,295 (29%) less at NP sites but were $6,273 (15%) greater at GMS sites. At both NP and GMS sites, costs were lower for IPCC patients in two subgroups: veterans over age 45 and veterans with high levels of inpatient service use before program entry. No interaction was noted between the impact of IPCC on costs and other clinical or sociodemographic characteristics. Similarly, no linear relationship was observed between the intensity of IPCC services and the impact of IPCC on VA costs, although the two sites that did not fully implement the IPCC program had the poorest results. With these sites excluded, the total cost of care for IPCC patients at GMS sites was $579 (3%) more per year than that for the control patients.

Implementing Evidence-Based Psychosocial Practices: Lessons Learned from Statewide Implementation of Two Practices

“…However, the experiences with demonstration projects funded by the National Institute of Mental Health's Community Support Program (CSP) 5 during the 1980s showed the need for more systematic attention toward barriers to successful implementation. During that time, many programs were poorly implemented or never implemented for lack of an adequate implementation plan, 6,7 inadequate leadership, 8 and/or lack of model specification. 9 Unfortunately, many of the common strategies used to promote model dissemination, such as workshops and didactic training, have little impact on practice.…”

Assertive community treatmentIssues from scientific and clinical literature with implications for practice

“…This consumer subgroup was consequently prone to frequent relapses and rehospitalizations. Applying the ACT approach to all consumers with severe mental illness seems inconsistent with the original intentions of the model, and attempts to apply the model more broadly have not been that successful [4,49].…”

Economic Impacts of Assertive Community Treatment: A Review of the Literature

“…Where data in the identified studies allowed, the percentage reduction in hospital days was calculated (Note 3). Three sites from multisite studies were excluded, which, according to study authors, had not implemented the model: site B (Fort Wayne) ofthe Bond and others 1988 study (38) and sites GMS-2 and GMS-5 of the Rosenheck and others 1995 study (45) of US Veterans Administration (VA) sites. This yielded 34 sites (Table 3).…”