Article

Efficacy and cost effectiveness of partial hospitalization

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Abstract

The partial-hospitalization modality is discussed and defined. Prior research on the efficacy and cost effectiveness of partial-hospitalization treatment is reported. To study the efficacy of partial hospitalization, goal attainment scaling was was used to generate change scores for a sample of 12 subjects over a 1-year period. The average change score for the total sample was +1.4, with 8 of the 12 subjects entering employment or training during the 1-year study. The efficacy of the partial-hospitalization program was supported. Limitations of these results are noted. To study the cost effectiveness of partial hospitalization, the number of hospitalizations and the number of days hospitalized, for comparable time spans, before and after entering day treatment were obtained. Since the partial-hospitalization modality reduced the hospitalization rate by 220% and reduced the number of days hospitalized by 440%, its cost effectiveness is supported.

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... Outcome studies of acute and intermediate levels of service intensity have shown that a policy of balancing resources among system components is consistent with both consumer needs and cost-effectiveness. These data have suggested that length of inpatient stay is unrelated to clinical outcome (72), that partial hospitalization and ultra-short hospitalization can generate clinical outcomes equivalent to traditional inpatient hospitalization (73)(74)(75)(76)(77), and that cost savings can be realized from alternatives to traditional hospitalization (73,(78)(79)(80)(81) that may enhance clinical outcomes (82). The policy of carefully limiting inpatient utilization to the minimum necessary while promoting access to outpatient services has also been empirically supported (83)(84)(85)(86). ...
... Outcome studies of acute and intermediate levels of service intensity have shown that a policy of balancing resources among system components is consistent with both consumer needs and cost-effectiveness. These data have suggested that length of inpatient stay is unrelated to clinical outcome (72), that partial hospitalization and ultra-short hospitalization can generate clinical outcomes equivalent to traditional inpatient hospitalization (73)(74)(75)(76)(77), and that cost savings can be realized from alternatives to traditional hospitalization (73,(78)(79)(80)(81) that may enhance clinical outcomes (82). The policy of carefully limiting inpatient utilization to the minimum necessary while promoting access to outpatient services has also been empirically supported (83)(84)(85)(86). ...
Article
This review examines the place of psychosocial rehabilitation services within community support systems in light of the need for mental health service systems to develop policies to direct the use of limited resources. Literature reporting experimental or quasi-experimental outcome studies of psychosocial rehabilitation interventions for persons with severe and persistent mental illnesses was reviewed, with a focus on skills training, family psychoeducation, and supported employment. A meta-analysis of the findings from recent outcomes studies was done. An integrative cost-outcome analysis examined allocation of resources among various levels of service intensity. The clinical characteristics and service needs of persons with serious and persistent mental illness vary significantly throughout the life cycle and course of the illness. Outcomes research strongly supports use of psychosocial rehabilitation but is insufficiently developed to determine the effects of service components used at varying levels of intensity and the interaction of those components with client characteristics, medication levels, or phase of the illness. Cost-effectiveness studies of psychosocial rehabilitation show an average reduction of more than 50 percent in cost of care due to reduced hospitalizations. Continued research is required to further specify the effects of psychosocial interventions and to determine the most effective amount and intensity of those interventions. Current evidence supports a policy of funding the psychosocial rehabilitation components of community support systems and balancing allocations for these systems among various levels of service intensity.
Article
The authors review includes: the historical background, standards, functional issues, efficacy and alternative models of care of partial hospitalization programs in North America. The emphasis is placed on those issues which are of relevance when planning alternative programs to inpatient hospitalization.
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