Community-based Case Management Program Research Articles

Self-Reported Mental Health and Addiction Outcomes of a Novel Community-Based Case Management Program for Frequent Emergency Department Users

Frequent emergency department users with mental illness or addiction often struggle to find the services they need. A pre-test/post-test design assessed outcomes for these individuals after participating in a novel community-based stepped-care program delivering individualized intensive case management services. Results indicated improvement in overall functioning and severity of anxious and depressive symptoms.

Protecting Your Professional Practice.

Lynn S. Muller, JD, BA-HCM, RN, CCM, began her career at Pace University as a registered professional nurse (RN), went onto earn her bachelor of arts degree in health care management at St. Peter's University of New Jersey, and then her Juris Doctor from Quinnipiac University School of Law. She is currently a practicing attorney and the managing partner of Muller & Muller. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the contributing editor of Professional Case Management: The Official Journal of the Case Management Society of America (CMSA) and the Commission for Case Management Certification (CCMC), a former member of the board of directors of CMSA of New York City. She is an adjunct professor at Saint Peter's University School of Nursing in the MSN and DNP Programs. Dr. Muller is the author of more than 80 articles in nursing and case management journals and listed on the NIH website. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways. Dr. Muller is the author of both legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and third edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Management Certification (CCMC), where she now serves on the Professional Development and Education Committee, is a certified facilitator for CCM CERTIFCATION 360, a Multi-day Immersion Program and other special projects. She is a contributor to the CCMC Case Management Body of Knowledge (CMBOK) and a past President of the New Jersey Chapter of CMSA. Dr. Muller is the former director of social services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as public defender, municipal court judge, and councilwoman, and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by email at: [email protected]. If you have an idea you would like to discuss, send your contact information by email and you will be contacted via your preferred method. The author reports no conflicts of interest.

Lessons Learned From a Veteran's Perspective.

Lynn S. Muller, JD, RN, BA-HCM, CCM, began her career at Pace University as a registered professional nurse (RN), went onto earn her Bachelor of Arts degree in Health Care Management at St. Peter's University of New Jersey, and then her Juris Doctor from Quinnipiac University School of Law. She is currently a practicing attorney and the managing partner of Muller & Muller. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the Contributing Editor of Professional Case Management: The Official Journal of the Case Management Society of America (CMSA) and the Commission for Case Management Certification (CCMC), a former member of the Board of Directors of CMSA of New York City. She is an adjunct professor at Saint Peter's University School of Nursing in the MSN and DNP programs. Dr. Muller is the author of more than 80 articles in nursing and case management journals and listed on the NIH website. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways. Dr. Muller is the author of both legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and 3rd edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Management Certification (CCMC), where she now serves on the Professional Development and Education Committee, is a Certified Facilitator for CCM CERTIFCATION 360 a Multi-day Immersion Program and other special projects. She is a contributor to the CCMC Case Management Body of Knowledge (CMBOK) and a past president of the New Jersey Chapter of CMSA. Dr. Muller is the former Director of Social Services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as public defender, municipal court judge, and councilwoman and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, RN, BA-HCM, CCM, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). You are Invited to share your knowledge and experience. Do you have a question or issue you would like to see addressed here? Questions are always welcome. We encourage and invite all readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. If you have an idea, you would like to discuss, or are considering being a first-time author, send your contact information by email and you will be contacted via your preferred method. All inquiries and submissions are accepted by email at [email protected] Case Management Matters welcomes and invites you to submit articles, stories, practice tips, reflections, and revelations. We encourage new/first-time authors and will work with you. How has case management changed you and/or how have you affected the lives of others? All inquiries, questions, comments, and manuscripts should be submitted via email to [email protected] or by mail to Lynn S. Muller, P.O. Box 164, Bergenfield, NJ 07621-0164. If you have an idea for an article, but would like to discuss it, provide contact information in your email and you will be contacted by your preferred method. The author reports no conflicts. The author reports no conflicts of interest.

Predictive Model-Driven Hotspotting to Decrease Emergency Department Visits: a Randomized Controlled Trial.

Emergency department (ED) visits contribute substantially to health care expenditures. Case management has been proposed as a strategy to address the medical and social needs of complex patients. However, strong research designs to evaluate the effectiveness of such interventions are limited. To evaluate whether a community-based case management program was associated with reduced ED utilization among complex patients. Patients whose risk exceeded a threshold were randomly assigned to a group offered case management or to the control group. Assignment occurred at five intervals between November 2017 and January 2019. Program effectiveness for all assigned patients was assessed using an intention-to-treat effect. Program effectiveness among those who received treatment was assessed using a local average treatment effect, estimated using instrumental variables. Both estimators were adjusted for baseline characteristics using linear models. Adults over age 18 with at least one health care encounter with Michigan Medicine or St. Joseph Mercy Health System between June 2, 2016, and November 27, 2018. Intervention arm participants (n = 486) were offered coordinated case management across medical, mental health, and social service organizations. Control arm participants (n = 409) received usual care. The primary outcome was the number of ED visits in the 6 months following randomization into the study. Secondary outcomes were 6-month counts of inpatient and outpatient visits. Of the 486 patients assigned to the intervention, 131 (27%) consented to receive case management. The intention-to-treat effect on ED visits was + 0.14 (95% CI: - 0.27 to + 0.55). The local average treatment effect among those who consented and received case management was + 0.53 (95% CI: - 1.00 to + 2.05). Intention-to-treat and local average treatment effects were not significant for secondary outcomes. The community case management intervention targeting ED visits was not associated with reduced utilization. Future case management interventions may benefit from additional patient engagement strategies and longer evaluation time periods. Clinicaltrials.gov Identifier: NCT03293160.

Mobile, Community-Based Buprenorphine Treatment for Veterans Experiencing Homelessness With Opioid Use Disorder: A Pilot, Feasibility Study.

Adults experiencing homelessness with opioid use disorder (OUD) utilize buprenorphine (BUP), a first-line medication for OUD, at very low rates. Innovative and tailored approaches are needed to reduce barriers to treatment and increase utilization of BUP in this population. This study describes a pilot Mobile Community-based Access Team (M-CAT) that used mobile technology and FaceTime in addition to existing community-based case management programs to provide BUP treatment for veterans with OUD experiencing homelessness who had difficulties engaging in the regular BUP clinic. We conducted a retrospective chart review of veterans enrolled in M-CAT or the usual BUP clinic between January 2015 and December 2017 (N = 36). We abstracted demographic, medical, substance use, prescription, health care utilization, and drug use data from medical records. Twelve veterans were enrolled in M-CAT and 24 were enrolled in BUP clinic. Mean retention in treatment was 19.2 months (standard deviation [SD] = 10.2) in M-CAT and 36 months (SD = 27.6) in BUP clinic. At the endpoint, 66.7% (n = 8) in M-CAT and 100% (n = 24) in BUP clinic remained on BUP. M-CAT is an innovative and tailored pilot project that successfully integrated specific OUD medication treatment into existing case management programs for veterans experiencing homelessness using mobile technology and Facetime. M-CAT can potentially increase utilization of BUP for OUD among high-risk population of veterans experiencing homelessness who are otherwise not engaged in treatment. Integrating telemedicine, BUP treatment, and community-based case management to treat OUD among veterans experiencing homelessness is feasible with high treatment retention. (Am J Addict 2020;29:485-491).

Is Legal Really Legal?: The Evolving World of Cannabis.

Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney and managing partner of Muller & Muller with a Bachelor of Arts degree in Health Care Management from St. Peter's University of New Jersey. She earned her Juris Doctor from Quinnipiac University School of Law in Connecticut. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the Contributing Editor of the journal Professional Case Management. She is an adjunct professor at St. Peter's University School of Nursing in the MSN and DNP programs. Dr. Muller is the author of more than 50 articles in nursing and case management journals and was featured in the Journal of Nurse Administrators. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways, the author of the Legal & Ethical Chapter of the sixth edition of the Case and Population Health Chapter for Leadership and Nursing Case Management by Diane L. Huber, published by Elsevier. Dr. Muller is the author of both legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and third edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Manager Certification (CCMC), where she now serves on the Professional Development and Education Subcommittee, is a facilitator for the CMCC360 2-Day Immersion Program, and is a contributor to the CCMC Case Management Body of Knowledge (CMBOK). She is a past President of the New Jersey Chapter of CMSA and the former Director of Social Services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as a public defender, a municipal court judge, a councilwoman, and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected]. If you have an idea you would like to discuss, send your contact information by e-mail and you will be contacted via your preferred method. The author reports no conflicts of interest.

Addressing Profound Disadvantages to Improve Indigenous Health and Reduce Hospitalisation: A Collaborative Community Program in Remote Northern Territory.

Background: Aboriginal people in rural and remote areas of the Northern Territory of Australia have suffered longstanding issues of homelessness and profound health and social inequities. The town and region of Katherine are particularly impacted by such inequities and have the highest rates of homelessness in Australia, composed almost entirely of Aboriginal people who represent 51% of the total population of 24,000 people. The region is serviced by a 60-bed hospital, and a small cohort of frequent attenders (FAs) represent 11% of the Emergency Department (ED) case load. The vast majority of FAs are Aboriginal and have very high burdens of social inequity and homelessness. FAs are a challenge to efficient and effective use of resources for most hospitals around the world, and investment in programs to address underlying social and chronic health issues contributing to frequent attendance have been demonstrated to be effective. Methods: These are the interim findings of a prospective cohort study using five sources of linked health and related data to evaluate a community-based case management pilot in a culturally competent framework to support frequent attenders to the Katherine Hospital ED. FAs were defined as people with six or more presentations in 12 preceding months. The intervention composed of a community-based case management program with a multi-agency service delivery addressing underlying vulnerabilities contributing to ED presentations. Results: Among this predominantly Aboriginal cohort (91%), there were high rates of homelessness (64%), food insecurity (60%) and alcohol misuse (64%), limited access to transport, and complex comorbidities (average of 2.8 chronic conditions per client). Following intervention, there was a statistically significant reduction in ED presentations (IRR 0.77, 95% CI 0.69–0.85), increased engagement with primary health care (IRR 1.90, 95% CI 1.78–2.03), and ambulance utilisation (IRR 1.21, 95% CI 1.07–1.38). Reductions in hospital admissions (IRR 0.93, 95% CI 0.77–1.10) and aeromedical retrievals (IRR 0.67, 95% CI 0.35–1.20) were not statistically significant. Conclusions: This study demonstrates the short-term impacts of community-led case management extending beyond the hospital setting, to address causes of recurrent ED presentations among people with complex social and medical backgrounds. Improving engagement with primary care is a particularly important outcome given the national impetus to reduce preventable hospital admissions.

Alternatives to Immigration Detention

The United States places over 440,000 people each year in immigration detention, far more than any other country in the world. This Article argues that there are compelling humanitarian and financial reasons to utilize more alternatives to detention. It examines the strengths and limitations of existing alternatives, including the need to develop more community-based case management programs and to rely less on electronic monitoring. The Article then sets forth several legal arguments under the Constitution, Rehabilitation Act, and international human rights law for requiring greater consideration of alternatives to detention.

Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia.

BackgroundA community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia. ObjectiveAssess the long-term effects of a community-based case management program for providing rehabilitations services to individuals with schizophrenia.MethodsA total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the case management group and 350 in the control group from two districts in Shanghai. Case management involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need (CAN), Positive and Negative Syndrome Scale (PANSS), WHO-Disability Assessment Scale (WHO-DAS), and the Quality of Life Scale (QOLS). Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as ‘self-determined medication discontinuation’.ResultsCompared to the treatment as usual group (i.e., follow-up management every 3 months), by the end of the two-year follow-up those who participated in the case management program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level (those with more education had higher discontinuation rates), lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort.ConclusionsCase management is a feasible and effective long-term method for improving the rehabilitation outcomes of community residents with schizophrenia. Our results highlight the need to involve family members in the management of patients’ medication, to use the minimum effective dosage of medication, and to aggressively manage all side-effects.

Caregivers’ acceptance of alternatives to long-term psychiatric hospitalization; lessons and debates from the South Korean situation

BackgroundA political movement towards building alternatives to long-term hospitalization of psychiatric patients in Korea has gained momentum. We aimed to provide sturdy foundation needed to formulate the most rational policy by review of caregiver’s opinion to the political alternatives under discussion for facilitating discharge of long-term stayed psychiatric patients in Korea.DiscussionCaregivers in Korea, whose family members had been hospitalized longer than 6 months and all of whom applied to the Mental Health Review Board (MHRB) for an examination required for extended stay, have shown reluctance to take their patients back home. Especially, a half of them answered that if MHRB would order compulsory discharge, they would take their patients to another hospital instead of living together. Despite of those pessimistic attitudes, one of the promising solutions might be residential care as an alternative to the long-term hospital care, which is most preferred by caregivers.ConclusionAfter all, the issue of who should take an accountability of the psychiatric patients is essential in establishing mental health policy. Korean government should analyze and reform mental health delivery systems such as residential service system, community-based case management programs and hospital treatment systems including payment program which can facilitate reasonable decision by professionals as well as caregivers for the appropriate admission rather than longer term hospitalizations.

A Study on the Effectiveness of Community-Based Case Management Program for the First Episode Psychosis

MethodsZZWe provided a case management program for first episode psychosis patients and assessed their symptoms, function, insight, and satisfaction using Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), Scale to assess Unawareness of Mental Disorder (SUMD), Global Assessment of Functioning Scales (GAF), and Quality of Life scales (QOL) at baseline and after the program. We also evaluated the treatment maintenance rate and the changes of their developmental task achievement.

Community-Based Case Management for Uninsured Patients With Chronic Diseases

To examine the effects of a community-based case management program on acute health care utilization and associated costs in uninsured patients with 1 or more chronic diseases. Large regional academic medical center that provides health care services for the vast majority of indigent patients in the area. This was a retrospective study of 83 patients who enrolled in a case management program between April 2007 and August 2008 on the basis of 1 or more emergency department visits or acute hospitalizations. Paired t tests were used to compare utilization and costs before and after enrollment. Overall, acute outpatient encounters decreased by 62% and inpatient admissions by 53%, whereas primary care visits increased by 162%. Participation in the case management program was also associated with a 41% reduction in overall aggregate costs, from $16,208 preintervention to $9,541 postintervention (p = .004). The results of this study suggest that intensive case management can reduce acute care utilization and costs and increase primary care follow-up among uninsured patients with certain chronic diseases.

Effects of community‐based case management by visiting nurses for low‐income patients with hypertension in South Korea

To assess the effects of a visiting nurse-driven community-based case management program for low-income adults with hypertension. This single group pretest-post-test study included 22 newly registered low-income adult patients with hypertension in a public health center in Seoul. Visiting nurses delivered a case management program for 2-8 months. Pretest and post-test measurements of blood pressure (BP), knowledge level, and self-management level in terms of diet, lifestyle, physical activity, and medication were obtained. The visiting nurse-driven case management was effective in reducing the BP level and improving the knowledge and self-management level of the low-income adults with hypertension in the community. This study serves as a baseline for visiting nurse-driven case management for low-income patients with hypertension. Its findings suggest that visiting nurse-driven case management targeting the self management of BP can foster improved BP control for newly diagnosed hypertensive patients in low-income populations.

Experiments in Coordinated Elder Care

Experiments in Coordinated Elder Care

Effects of Community-based Case Management Program for Clients with Hypertension

The purpose of this study was to analyze effects of a community-based case management program for clients with hypertension living in the community. The research design was a one group pre and post-test design with 30 participants with hypertension who agreed to participate in the 8-12 week case management program provided by case managers from the National Health Insurance Corporation in 2002. Data were collected three times, before and after the case management services, and 6 months later. Outcomes included changes in blood pressure, knowledge of hypertension and daily life practices, including alcohol consumption, smoking, exercise, and medication adherence. Repeated-measures ANOVA and post-hoc tests of means revealed significant differences before and after service for systolic blood pressure, daily life practices (monitoring body weight and BP, low salt and cholesterol and high vegetable diet, and stress-relief practices), and exercise. The goal for medication adherence was attained after service. Significant improvements from baseline to 6 months after service were observed in measures of salt and vegetables in diet. There were no significant differences on hypertension knowledge, alcohol consumption or smoking behavior between before service and after, and at 6 months. The findings provide preliminary evidence that case management intervention can have positive outcomes on BP control, daily life practices, exercise, and medication adherence for clients with hypertension. However, additional interventions are needed to sustain long-term effects.

Evaluating the Social and Economic Impact of Community‐Based Prenatal Care

This article describes the evaluation and findings of a community-based prenatal care program, Omaha Healthy Start (OHS), designed to reduce local racial disparities in birth outcomes. This evaluative study used a comparative descriptive design, and Targeting Outcomes of Programs was the conceptual framework for evaluation. The evaluation followed 3 groups for 2 years: OHS birth mothers (N=79; N=157); non-OHS participant birth mothers (N=746; N=774); and Douglas County birth mothers (N=7,962; N=7,987). OHS provided case management, home visits, screening, referral, transportation, and health education to participants. Program outcome measures included low birth weight, infant mortality, adequacy of care, trimester of care, and costs of care. OHS birth outcomes improved during year 2, and there was a 31% cost saving in the average hospital expenditure compared with the nonparticipant groups. Preliminary evaluative analysis indicates that prenatal case management and community outreach can improve birth outcomes for minority women, while producing cost savings. Further prospective study is needed to document trends over a longer period of time regarding the relationship between community-based case management programs for minority populations, birth outcomes, and costs of care.

Unmet need for medical care among homeless adults with serious mental illness

Objective The objective of this study was to determine the rates and predictors of unmet medical needs among homeless adults with serious mental illness entering a community-based case management program and those of receipt of medical care in the subsequent 3-month period. Methods We analyzed baseline and follow-up data for 7213 homeless clients in the multisite Access to Community Care and Effective Services and Supports program. Results Overall, 43.6% of the sample reported having an unmet need for medical care at baseline; of these subjects, only 36.1% received medical services during the 3 months following program entry. Using multivariate logistic regression modeling, we found that, at baseline, independent correlates of an unmet medical need included lower educational level, increased depressive and psychotic symptoms and greater number of potentially competing needs. None of these variables, however, adversely affected the likelihood of receiving medical care during follow-up. Factors associated with receiving medical services in the 3 months following program entry included receiving outpatient psychiatric services and reporting stronger therapeutic alliance with one's case manager. Conclusions Collaborative case management may play an important role in meeting mentally ill homeless persons' medical needs. Greater efforts are needed to identify and link at-risk clients with appropriate medical services.

HIV Testing and Receipt of Test Results Among Homeless Persons With Serious Mental Illness

The purpose of this study was to determine the rates and predictors of HIV testing and receipt of results among homeless adults with serious mental illness in the initial 3-month period after contact with a community-based case management program. Baseline and follow-up interview data came from clients (N=5,890) in the Access to Community Care and Effective Services and Supports program, an 18-site, 5-year federally sponsored demonstration designed to evaluate the effect of service system integration on outcomes for homeless persons with serious mental illness. Overall, 38.0% of clients were tested for HIV in the 3 months after program entry; of these, 88.8% returned to receive their test results. Likelihood of being tested was independently associated with having been tested before, more severe psychiatric symptoms and drug problems, level of worry about getting AIDS, younger age, less education, minority status, longer-term homelessness, being sexually assaulted, being arrested, and health services utilization. Among those tested, likelihood of receiving the test results was higher among those with a history of prior testing and return for results, a higher frequency of testing, and more years of education and lower among those with drug abuse problems, outpatient medical service utilization, disability, and sexually transmitted disease. Interaction analyses showed that, for men, greater social support increased the likelihood of both HIV testing and receipt of results, while sexual victimization during follow-up decreased the likelihood that men would return for their HIV results. The majority of homeless clients enrolled in an intensive case management program were not tested for HIV during the 3-month period after program entry. Among those tested, however, nearly 90% reported receiving their results. The findings may enhance the development and targeting of strategies to increase testing and awareness of HIV serostatus among high-risk mentally ill homeless persons.

Providing Comprehensive Case Management Services to Urban Women with HIV/AIDS and Their Families

Women continue to be disproportionately affected with HIV. Women with HIV/AIDS are also more likely than their male counterparts to be single heads of households and primary providers for their children. Social workers are ideally suited to recognize the psychosocial complexities that HIV/AIDS entails for women and how such circumstances can interfere with medical management and meeting children’s needs. This article discusses the literature relevant to women with HIV/AIDS and case management and describes a community-based case management program that was designed to serve urban women with newly diagnosed or newly disclosed cases of HIV/AIDS and their families.

Reducing psychiatric hospitalization among mentally ill veterans living in board-and-care homes.

The effectiveness of a community-based case management program at the Veterans Affairs West Los Angeles Healthcare Center in reducing hospital readmission of mentally ill veterans living in privately operated board-and-care homes was evaluated. A retrospective cohort design was used. The sample consisted of 321 patients identified by hospital records as living in one of 24 board-and-care homes in the Los Angeles area that were approved by the community residential care program. A total of 214 subjects who received monthly home visits from case managers (program group) were compared with 107 subjects who did not receive monthly home visits (comparison group). The median number of psychiatric bed-days used was calculated for the two years before and after follow-up. The number of days from the start of follow-up to the first psychiatric hospitalization was also calculated. Among subjects in the program group, the median number of psychiatric bed-days used decreased significantly, from 59 days to 50 days. No significant change in the median number was observed for comparison subjects. Comparison subjects were rehospitalized 1.7 times more often than program subjects. Overall, program subjects under age 62 (younger subjects) were rehospitalized 2.5 times more often than older subjects. In the program group, those who had received home visits for more than two years were hospitalized three times more often than those who had received visits for less than two years, and younger subjects were rehospitalized 1.8 times more often than older subjects. The findings suggest that home visits conducted by case managers in a community residential care program helped reduce psychiatric hospitalization among veteran patients living in privately operated board-and-care homes.