Clarke St. Dennis Michael Hendryx Anne-Lenora Henriksen Stephen M. Setter Brandy Singer
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Objectives: The purposes of this study were
to (1) examine the cost of community-based health care services for geropsychiatric inpatients
discharged into the community after the closure of an inpatient state geropsychiatric unit and
(2) compare costs for patients treated with extra
support through an Expanded Community Services (ECS) program to patients treated traditionally.
Method: This study was a 6-month
prospective, observational analysis of 30 patients
discharged in conjunction with a ward closure in October 2002 (17 patients were
nonrandomly assigned to the ECS program, and 13, to
standard care). We analyzed costs of care, mortality,
and rehospitalization rates derived from Medicaid paid claims and other data sources and
compared costs to an estimate of hospital costs had the
patients not been discharged. Patients were discharged to various community placements
including long-term care facilities, assisted
living facilities, and adult family homes in
Eastern Washington State.
Results: Costs for community care were
approximately half of estimated costs for hospital care. Patients treated in the ECS program,
representing the most severely in-need discharges,
had costs of care that were nonsignificantly
higher than non-ECS patients but still significantly
lower than estimated hospital care. No differences
in mortality or rehospitalization rates were found between ECS and non-ECS patients.
Conclusion: Costs of community care
were significantly lower than hospital care. Quality
of life for patients in the community settings
versus the hospital was not assessed. The ECS
program was able to maintain high-risk
geropsychiatric patients in the community comparably to
less severely ill patients at less than hospital
costs. Recommendations are provided for ways to
establish community treatment programs for deinstitutionalized elderly patients with
serious mental illness.
Prim Care Companion J Clin Psychiatry 2006;8(5):279-284
https://doi.org/10.4088/PCC.v08n0504
© Copyright 2006 Physicians Postgraduate Press, Inc.