UPBEAT: The impact of a psychogeriatric intervention in VA medical centers

BACKGROUND. The Unified Psychogeriatric Biopsychosocial Evaluation and Trea tment (UPBEAT) program provides individualized interdisciplinary mental hea lth treatment and care coordination to elderly veterans whose comorbid depr ession, anxiety, or alcohol abuse may result in overuse of inpatient servic es and underuse of outpatient services, OBJECTIVES. TO determine whether proactive screening of hospitalized patien ts can identify unrecognized comorbid psychiatric conditions and whether co mprehensive assessment and psychogeriatric intervention can improve care wh ile reducing inpatient use. DESIGN, Randomized trial, SUBJECTS. Veterans aged 60 and older hospitalized for nonpsychiatric medica l or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). MEASURES. The Mental Health Inventory (MHI) anxiety and depression subscale s, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Ite m Health Survey Short Form (SF-36), inpatient days and costs, ambulatory ca re clinic stops and costs, and mortality and readmission rates. RESULTS. Mental health and general health status scores improved equally fr om baseline to 12-month follow-up in both groups. UPBEAT increased outpatie nt costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $ 3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156), Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and po stenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069), CONCLUSIONS, UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improv ement in mental health and general health status as usual care.