ABSTRACT
The Comprehensive Substance Abuse Treatment and Rehabilitation (CSTAR) program is described, and a study of its services is presented. The CSTAR program is a community program with wrap-around services and intensive case management. Eleven domains typically affected by substance abuse were measured, plus satisfaction with treatment services. A retrospective study of 280 clients at 10 facilities was done, and results analyzed separately by General Programs. Women with Children programs, and Adolescent programs. A small sample of clients who were early in their treatment was re-interviewed 90 days later. Data were also examined according to length of stay in the program. Results were consistently positive, and increased with length of time in the program.
Subject(s)
Alcoholism/rehabilitation , Substance-Related Disorders/rehabilitation , Activities of Daily Living , Adolescent , Adult , Alcoholism/psychology , Consumer Behavior , Crime , Employment , Female , Humans , Male , Missouri , Parenting , Psychiatric Status Rating Scales , Sampling Studies , Substance-Related Disorders/psychology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
A single site pre-post study of seriously mentally ill patients treated in a public mental health system shows that annual treatment costs can be substantially reduced with the use of day hospital treatment. Two cohorts of psychiatric patients--282 consecutive admissions to a traditional public inpatient unit in 1980, and 340 consecutive admissions to a combination of inpatient and day hospital care in 1984--were followed 12 months after admission. The substitution of the day hospital is made possible because the facility provided a dormitory residence for those who could not go home at night. Cost savings per hospital episode are about 31 per cent when the additional costs of day hospital and residence are considered. Cost shifting from inpatient to residential sites is noted, but overall mean annual costs, when all other treatment (including additional admissions), residential and family costs were included, are reduced. Readmission rates did not rise. The generalizability of the findings is limited to public mental health centers and state hospitals.
Subject(s)
Cost Control/methods , Mental Health Services/organization & administration , Outpatient Clinics, Hospital/organization & administration , Adult , Cohort Studies , Female , Follow-Up Studies , Humans , Length of Stay , Male , Massachusetts , Mental Health Services/economics , Outpatient Clinics, Hospital/economics , Outpatient Clinics, Hospital/statistics & numerical data , Patient Discharge , Patient ReadmissionABSTRACT
A form of cost--benefit analysis is used to measure the efficiency and effectiveness of an alcoholism treatment program in caring for patients grouped by year of admission, sex and level of impairment.
Subject(s)
Alcoholism/therapy , Cost-Benefit Analysis , Female , Humans , Income , Male , Sex FactorsABSTRACT
Three alternative methods for obtaining anticipated resource utilization information for comprehensive mental health centers are proposed. The methods differ on two dimensions, sample selection and statistical technique. Using an admission cohort rather than a discharge cohort and eliminating patients who terminated treatment against medical advice permitted a refined prediction. Although no significant differences were found between the chi-square and multiple-regression techniques, the latter resulted in a substantially greater degree of flexibility.
Subject(s)
Mental Health Services/statistics & numerical data , Humans , Length of Stay , Patient Dropouts , Regression Analysis , Research Design , Statistics as TopicABSTRACT
This study analyzes the relationship between program performance and workload levels. The results indicate that program effectiveness is highest under medium workloads while efficiency is greatest under high workloads. The management dilemma resulting from these findings is discussed.
Subject(s)
Cost-Benefit Analysis , Medical Staff, Hospital/statistics & numerical data , Mental Health Services , Efficiency , Evaluation Studies as Topic , Humans , Length of Stay , Mental Disorders/rehabilitationABSTRACT
The application of output value analysis, a type of benefit/cost analysis, to a psychiatric patient population is reported. A method for discounting the value of the program if a patient was readmitted within a year after discharge was introduced. The application of this discount factor reduces the value produced by the program and thereby reduces both productivity and effectiveness indices. When applied to groups known to differ in readmission rates, such as first admissions and readmissions or voluntary and involuntary admissions, the discount factor can accentuate group differences markedly. When selected diagnostic groups were compared, the discount factor could even reverse the relative standing of the groups.
