A Patient-Centered and Cost-Effective Psychiatric Inpatient Alternative: Model for the Future?

Lohr JB, Hawthorne WB, Green EE, Mittman BS, Lee M, Garcia P, Hough RL, Gilmer T. A Patient-Centered and Cost-Effective Psychiatric Inpatient Alternative: Model for the Future? Paper presented at: VA HSR&D National Meeting; 2002 Feb 14; Washington, DC.

Related HSR&D Project(s)

• PCC 98-051 – Patient-Centered Alternative to Psychiatric Hospitalization for Veterans

Objectives: A variety of models of psychiatric hospital alternative care have been developed over the past several decades. Founded over 20 years ago, San Diego's Short-Term Acute Residential Treatment (START) is one of the most developed of these alternatives, now comprising a network of 6 facilities with a total of 77 beds. The study will test the hypotheses that START will be more cost-effective and that veterans who receive care at START will demonstrate greater improvement in symptoms, functioning, and quality of life, as well as greater satisfaction with treatment, than veterans treated at the VA inpatient unit, both at discharge and follow-up intervals. Methods: This study's design is a hybrid of efficacy and effectiveness studies. VA psychiatric unit treatment and START are compared in a randomized trial, with follow-up of subjects at 2, 6, and 12 months as they experience real-world treatment-as-usual. Symptoms, functioning, quality of life, and satisfaction with services are assessed by multiple standardized measures, as well as by qualitative assessments. Results: A preliminary calculation of mean episode costs (mean length of stay x daily cost) yields costs of $6,976 for the hospital group and $2,775 for START veterans. Preliminary results also include statistically significant findings of higher levels of satisfaction with START than hospital treatment, on four items from the Perceptions of Care. Similarly, on the Ward Atmosphere Scale, START subjects rated their treatment environment more favorably on six out of ten subscales. With regard to symptoms and functioning, treatment gains between admission and discharge are very similar for START and hospital subjects on both clinician-rated (SCI-PANSS) and self-report (SF-36V) measures. The preliminary START subjects show greater improvement at 2 months, but not at statistically significant levels. Conclusions: Preliminary results suggest the START model may be cost-effective alternative to psychiatric inpatient unit treatment and one that leads to higher levels of patient satisfaction among veterans. Impact statement: This study's results will have implications both within and outside VHA. This is the first study of a psychiatric hospital alternative focusing specifically on veterans and has considerable economic implications. Positive findings could lead to the development of START-like programs at other locations around the country. Given VHA's status as the largest public-sector mental health service provider nationwide, this could have a major impact outside VHA as well.