Bridging the gap between psychiatric hospitalization and community care: Cost and quality outcomes*1

Abstract

Background : Current changes in the health care system require the development of interventions that reduce length of stay and provide alternatives to hospitalization while maintaining quality and consumer satisfaction. Objectives : The objectives were to (a) investigate differences in quality indicators for patients receiving case management services; (b) measure satisfaction of patients enrolled in the case management intervention; and (c) reduce costs related to high utilization of services as a result of recidivism and rehospitalization. Study Design : Inpatients were randomly assigned to either an intervention (n = 121) or control group (n = 122). The intervention group received transitional case management services; the control group received traditional care. Results : No differences were found between the two groups on the Beck Depression Inventory or the Mini-Mental Status Examination. Ninety-six percent of the patients and 95% of their caregivers were very pleased with the case management intervention. Fewer patients in the intervention group (9 vs. 16 in the control group) were readmitted to the hospital over the course of the project. Similarly, only 1 patient in the intervention group versus 18 patients in the control group used the emergency department. Even considering the cost of providing case management services, an overall savings of $175,375 occurred for the intervention group. Conclusions : Transitional case management services maintained quality and reduced costs with a high level of consumer satisfaction. (J Am Psychiatr Nurses Assoc [1999]. 5, 46–53)