D. Salkever et al., Assertive community treatment for people with severe mental illness: The effect on hospital use and costs, HEAL SERV R, 34(2), 1999, pp. 577-601
Citations number
15
Categorie Soggetti
Public Health & Health Care Science","Health Care Sciences & Services
Objective. To determine the effect of the Program for Assertive Community T
reatment (PACT) model on psychiatric inpatient service use in a population
of non-emergency psychiatric patients with severe chronic mental illness, a
nd to test for variations in this effect with program staffing levels and p
atient 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 t
hrough July 1991.
Study Design. Subjects were randomly assigned either to one of two PACT pro
grams 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 regressio
n analysis.
Data Collection Methods. Data were obtained from Medicaid claims, chart rev
iews, subject, case manager, and family interviews; searches of the compute
rized patient and financial databases of the South Carolina Department of M
ental Health and relevant hospitals; and searches of the hard copy and comp
uterized financial databases of the two major local hospitals providing inp
atient 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 ol
der patients. Lower PACT client/staff ratios also reduced the risk of hospi
talization. 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 h
ospitalizations but the size of this effect varies with patient and program
characteristics. This study shows that previous results on PACT can be app
lied to non-emergency patients even when the control condition is an up-to-
date CMHC office-based case management program.