The effects of public managed care on patterns of intensive use of inpatient psychiatric services (Reprinted from Psychiatric Services, vol 49, pg 327-332, 1998)

Objective: The study examined the characteristics of frequent users of inpa tient treatment under public-sector managed care in Massachusetts between 1 992 and 1995 and explored whether their pattern of inpatient utilization af fected their overall use of hospital days, Methods: Individuals with five o r more admissions in any of four fiscal years (1992 to 1995) were identifie d using the Massachusetts Department of Mental Health client tracking syste m. The demographic and clinical characteristics of these patients and the t y-pes of hospitals they used were compared with those of all patients in ca se management programs who had a hospital admission but who did not meet st udy criteria for multiple admissions. Results: Compared with other patients , patients with multiple admissions were more likely to be young Caucasian females with personality disorder and a history of substance abuse but not a current substance use disorder. They tended to be lower functioning as me asured by the Georgia Role Functioning Scale (GRFS) and to have higher leve ls of distress, as measured by the global personal distress portion of the GRFS. They made up 6 to 8 percent of all clients with a psychiatric admissi on who were enrolled in a case management program, but they accounted for 2 1 to 27 percent of all admissions in the four fiscal years. Patients with m ultiple admissions had significantly longer lengths of stay when admitted t o a hospital where they had not been previously admitted in the past 12 mon ths. Conclusions: States setting up public-sector managed care or revising existing public-sector managed care contracts should ensure that subpopulat ions of persons at high risk for multiple admissions receive special attent ion. They should also create networks of inpatient providers to enable freq uent users of acute care facilities to return to the same facility that pre viously discharged them.