Assertive community treatment for people with severe mental illness: The effect on hospital use and costs

David Salkever, Marisa Elena Domino, Barbara J. Burns, Alberto B. Santos, Paul A. Deci, James Dias, H. Ryan Wagner, Richard A. Faldowski, Jan Paolone

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objective. To determine the effect of the Program for Assertive Community Treatment (PACT) model on psychiatric inpatient service use in a population of nonemergency psychiatric patients with severe chronic mental illness, and to test for variations in this effect with program staffing levels and patient characteristics such as race and age. Data Sources/Study Setting. Data are taken from a randomized trial of PACT in Charleston, South Carolina for 144 patients recruited from August 1989 through July 1991. Study Design. Subjects were randomly assigned either to one of two PACT programs or to usual care at a local mental health center. Effects on hospital use were measured over an 18-month follow-up period via multiple regression analysis. Data Collection Methods. Data were obtained from Medicaid claims, chart reviews, subject, case manager, and family interviews; searches of the computerized patient and financial databases of the South Carolina Department of Mental Health and relevant hospitals; and searches of the hard copy and computerized financial databases of the two major local hospitals providing inpatient psychiatric care. Principal Findings. PACT participants were about 40 percent less likely to be hospitalized during the follow-up period. The effect was stronger for older patients. Lower PACT client/staff ratios also reduced the risk of hospitalization. No evidence of differential race effects was found. Given some hospital use, PACT did not influence the number of days of use. Conclusions. Controlling for other covariates, PACT significantly reduces hospitalizations but the size of this effect varies with patient and program characteristics. This study shows that previous results on PACT can be applied to non-emergency patients even when the control condition is an up-to-date CMHC office-based case management program.

Original languageEnglish (US)
Pages (from-to)577-601
Number of pages25
JournalHealth Services Research
Volume34
Issue number2
StatePublished - Jun 1 1999

Fingerprint

Community Mental Health Services
Hospital Costs
mental illness
costs
community
Psychiatry
Inpatients
Mental Health
Hospitalization
Personnel Management
Insurance Claim Review
Databases
Community Mental Health Centers
hospitalization
Information Storage and Retrieval
Medicaid
Case Management
psychological care
mental health
staffing level

Keywords

  • Assertive community treatment
  • Psychiatric costs
  • Psychiatric hospitalization
  • Severe mental illness

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Salkever, D., Domino, M. E., Burns, B. J., Santos, A. B., Deci, P. A., Dias, J., ... Paolone, J. (1999). Assertive community treatment for people with severe mental illness: The effect on hospital use and costs. Health Services Research, 34(2), 577-601.

Assertive community treatment for people with severe mental illness : The effect on hospital use and costs. / Salkever, David; Domino, Marisa Elena; Burns, Barbara J.; Santos, Alberto B.; Deci, Paul A.; Dias, James; Wagner, H. Ryan; Faldowski, Richard A.; Paolone, Jan.

In: Health Services Research, Vol. 34, No. 2, 01.06.1999, p. 577-601.

Research output: Contribution to journalArticle

Salkever, D, Domino, ME, Burns, BJ, Santos, AB, Deci, PA, Dias, J, Wagner, HR, Faldowski, RA & Paolone, J 1999, 'Assertive community treatment for people with severe mental illness: The effect on hospital use and costs', Health Services Research, vol. 34, no. 2, pp. 577-601.
Salkever D, Domino ME, Burns BJ, Santos AB, Deci PA, Dias J et al. Assertive community treatment for people with severe mental illness: The effect on hospital use and costs. Health Services Research. 1999 Jun 1;34(2):577-601.
Salkever, David ; Domino, Marisa Elena ; Burns, Barbara J. ; Santos, Alberto B. ; Deci, Paul A. ; Dias, James ; Wagner, H. Ryan ; Faldowski, Richard A. ; Paolone, Jan. / Assertive community treatment for people with severe mental illness : The effect on hospital use and costs. In: Health Services Research. 1999 ; Vol. 34, No. 2. pp. 577-601.
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