Seriously mentally ill patients are at very high risk for psychotic relapse, suicide, violence, rapid re-hospitalization and a variety of adverse outcomes during the period following hospital discharge. Successful transition from inpatient to outpatient treatment can reduce these risks. It is important to optimize the timeliness and adequacy of outpatient follow-up in order to reduce costs and improve patient outcomes. While previous work has evaluated correlates of enhanced retention in psychiatric treatment, few studies have specified interventions that directly target and improve continuity of care.
The critical time intervention (CTI) model is intended to enhance the continuity of mental health services for mentally ill veterans by bridging the gap between institutional and community based services. Veterans determined to be at high risk for treatment drop out or delayed follow up care, but not eligible for the Mental Health Intensive Case Management team, will be included.
This study used an experimental random-assignment design to test the effectiveness of a brief 3-month, CTI for veterans with SMI at the point of inpatient-outpatient transition. The goals of the CTI were to increase treatment retention in outpatient psychiatric care, including more timely and continuous outpatient care after inpatient discharge, as well as reduce recidivism and emergency room visits, and improve psychiatric symptoms. The comparison condition was usual care. We aimed to enroll 240 subjects from the VISN, with 120 in each condition (sixty subjects from each site). This manualized CTI was be delivered by a social worker/nurse case manager with psychiatrist back-up and supervision. Subjects were interviewed at baseline (time of discharge) and three months post-discharge. Other data on health services utilization were to obtained from VHA administrative encounter databases.
The study is now closed to enrollment and all interviews have been completed. We succeeded in enrolling 170 subjects across all four sites: Baltimore and Perry Point (N=82), Washington DC (N=55) and Martinsburg, WV (N=33). There were no SAE's or AE's over the past year. During the course of recruitment locally 13 people were withdrawn after consent. They were withdrawn for the following reasons: pt changed mind and no longer wanted to be in study = 3, pt was discharged to extended care = 4, pt was homeless at time of discharge = 1, pt had change in diagnosis at time of discharge = 2, pt moved = 1, pt was not discharged during recruitment window/ long term hospitalization = 1, and pt enrolled in clinical trial simultaneously and could not participate in both studies = 1. Currently we are obtaining services information from the VA databases to complete the data collection phase of this study. There are no results to report at this time.
Our study will provide important insight into the process of preventing treatment drop-out and adverse events commonly associated with transition from inpatient to outpatient care. This study will help determine cost-effective ways to deliver improved continuity of care for people with psychiatric needs.
- Hackman A, Brown C, Yang Y, Goldberg R, Kreyenbuhl J, Lucksted A, Wohlheiter K, Dixon L. Consumer satisfaction with inpatient psychiatric treatment among persons with severe mental illness. Community mental health journal. 2007 Dec 1; 43(6):551-64.