1. printed by www.postersession.com A Follow-Up Study of Patterns of Service Use and Cost of Care for Discharged State Hospital Clients in Community-Based Settings Sungeun Lee, MSW, Aileen B. Rothbard, Sc.D., Kenneth Culnan, M.Ed., Sandra Vasko, M.Ed. University of Pennsylvania, Philadelphia Department of Behavioral Health/Mental Retardation Services ■ Although there has been a substantial body of knowledge that points to the short-term benefits of community-based services, there has been a dearth of research as to the longer- term effects of deinstitutionalization. ■ Most of these studies evaluating the effects of deinstitutionalization were done in the first few years following discharge with little follow-up thereafter. ■ Moreover, previous studies have focused primarily on the behavioral outcomes of deinstitutionalization, although increasing attention is being given to the services people with severe mental illness (SMI) receive in the community and cost of the care for this population. ► ► During 2002, 14% of the subjects had an inpatient psychiatric admission to community hospitals and average of 54 days per year of hospitalization. Almost all of the subjects received some form of outpatient mental health care other than case management (94%) and 69% were in publicly funded residential programs. ► ► The cost per study subject for a comprehensive package of services including psychiatric, medical, residential and pharmacy was $71,232. Residential care accounts for the largest share of expenditures (65%) and is approximately %5,400 per month per residential user and includes residential staff and other housing support costs provided by the programs. ► ► Jail records showed that in the 2002 cohort, 6 individuals (3%) were admitted to jails between 1989 and 2005, and 20 individuals (9%) were homeless. Vital statistics and other clinical record sources found that 37% of the original group of 590 individuals discharged in 1987-89 died. Study Design: ■ Study Design: A longitudinal one group pre-post design was used to examine service utilization, costs of the subjects over a 10 year period (2002). Each person had a time line that began on the date of his or her state hospital discharge. A longitudinal service history on these individuals was constructed to determine what their pattern of care as well as their cost is in the community today. Sample: ■ Sample: Among 590 individuals discharged from Philadelphia State Hospital between 1989 and 1993, 206 individuals were selected based on the availability of administrative data from Medicaid during 2002. Data Sources: ■ Data Sources: Data consisted of the service use and cost information abstracted from Medicaid claims records and county service data provided information on residential care and Community Treatment Services. Analysis: ■ Analysis: ► ► Average service utilization rate per user was constructed by type and year of service. The per-subject measure is the mean value of the study group (N=206), whereas the per-user measure characterizes the care for the subjects who received services in the year. Service units were measured in day, visits, or contacts, and pharmaceutical information was based on the type of drug and the percentage of users. ► ► State hospital costs were derived from Pennsylvania cost reports on State Hospitals. The per diem cost of caring for patients in 2005 was $158,000 a year. This analysis suggests that individuals discharged from state institutions have been integrated into community residential settings and receiving psychiatric outpatient treatment on a regular basis at a much reduced cost compared to the $158,000 per year cost of state hospitalization in 2002. In addition, their acute care psychiatric admissions and days have decreased and their cost of care for a similar package of services has decreased between 1992 and 2002 ($71,801 per subject in 1992 adjusted dollars using the 2002 CPI versus $68,112 in 2002). ■ This is a follow-up study of patients discharged from a state hospital in 1989 whose use and cost of care was last documented in 1992 three years after discharge. ■ The current longitudinal study aims to document the utilization and cost of care of discharged clients in 2002 in contrast to the current cost of institutionalization. BACKGROUND PURPOSE OF THE STUDY RESEARCH METHODSRESULTS CONCLUSIONS SAMPLE CHARACTERISTICS (N=206) Variables%Mean (SD) Gender (Male)60 Race (African American)58 Age at discharge 50 (10) Marital Status (Not married)78 Diagnosis (Schizophrenia)88 Eligibility Status (SSI)73 GAF36 (13) Length of Stay in Philadelphia State Hospital (years) 6.07 (8.14) Annual Cost of PSH Cohort in 2002 (N=206) Annual Service Utilization in 2002 %Mean Psychiatric services Inpatient (days) Case management (hours) Partial hospitalization Psychiatric clinic Soc. Voc rehabilitation Residential (days) Pharmacy Psychotropic medication Other medication Drug and alcohol services Outpatient (contacts) Health care services Inpatient (days) Outpatient 16 94 36 18 35 65 88 75 1 5 82 54.1 69.7 390.2 4.8 595.6 333.2 ∙ 5 2.7 21.2