EFFECTS OF DIAGNOSIS, DEMOGRAPHIC CHARACTERISTICS, AND CASE-MANAGEMENT ON REHOSPITALIZATION

Objectives: A randomized controlled study was conducted to assess the effects of case management and patients' characteristics on the use of inpatient psychiatric services. Methods: Inpatients discharged from H arlem Hospital Center in 1984-1985 were randomly assigned to an outrea ch case management team or standard aftercare. Analysis of variance wa s used to assess the main effects and two- and three-way interaction e ffects of treatment status, gender, age, substance abuse, and diagnosi s on the number of days of psychiatric rehospitalization in state and city community hospitals. Results: In the follow-up period, 75 of the 146 patients in the case management group (51.4 percent) and 51 of the 143 patients in the control group (35.7 pet-cent) were rehospitalized for psychiatric care, On average, patients spent 31.1 days in city ho spitals and 26.6 days in state hospitals. Members of the case manageme nt team spent a mean total of 18.1 hours a month in direct and indirec t care for each patient. They spent most time with substance-abusing o lder women. Significant three-way interaction effects were found betwe en treatment status and diagnosis and gender, diagnosis and age, and d iagnosis and substance abuse on the number of days patients spent reho spitalized for psychiatric care in city and state hospitals. Conclusio ns: It is unlikely that case management intervention will reduce rehos pitalization rates unless appropriate and effective outpatient and com munity services are available. Effective surveillance of patient popul ations by case managers frequently results in rehospitalization as the only treatment alternative if other options for meeting the needs and resolving the crises of patients are not available.