Recidivism among Veterans with Schizophrenia Living in Board and Care: An Outcome Evaluation of the Community Residential Care Program

Mares A, McGuire J. Recidivism among Veterans with Schizophrenia Living in Board and Care: An Outcome Evaluation of the Community Residential Care Program. Paper presented at: VA HSR&D National Meeting; 1999 Feb 24; Washington, DC.

Objectives: Recidivism-the repeated use of inpatient services--among veterans diagnosed with schizophrenia is an important problem. In FY96, veterans with schizophrenia consumed 21% of all inpatient bed days while representing only 4% of the total inpatient population. Health providers are increasingly using intensive community-based case management interventions such as Assertive Community Treatment (ACT) and Intensive Psychiatric Community Care to reduce the risk of recidivism. While much is known about intensive community interventions (especially ACT), little is known of the effectiveness of less intensive community interventions, such as the Community Residential Care (CRC) Program, in reducing the risk of recidivism. CRC provides schizophrenic veterans and others who live in privately operated board and care homes with monthly home visits. The purpose of this study is to estimate the effect of CRC home visits on the risk of recidivism among patients at West Los Angeles VAMC. Methods: A retrospective cohort study design was used. A group CRC patients (N = 214) was followed from their first CRC home visit until 8/31/98 for first psych/SA and med/surg admission. DHCP Patient File was queried on 9/17/98 for all patients matching the street address or facility name of one of the 27 participating board and care homes. A total of 321 matches were made-214 CRC patients and 107 non-CRC patients. All 214 CRC patients (52% of the total CRC patient roster) were included in the study. This method of selecting subjects was chosen to allow for future comparisons of inpatient lengths of stay among CRC and matched comparison subjects. Five secondary data sources were used. DHCP Patient, Outpatient Clinic Visit, and Patient Treatment Files provided data on socio-demographics, CRC home visits, and hospitalizations, respectively. The CRC program database provided additional licensing data on board and care homes. Psychiatric/substance abuse (psych/SA) and medical/surgical (med/surg) hospitalizations were defined based on discharge ward. Twenty inpatient wards were designated psych/SA wards and forty wards as med/surg. All domiciliary and nursing home admissions were excluded. Cox regression was used, in concert with the Andersen Behavioral Model, to identify recidivism risk factors. Twelve dichotomized covariates were included: visit duration, worker profession, home size, age, marital status, race, income, service connected percentage, family support, psychiatric diagnosis, symptoms, and alcohol/substance abuse diagnosis. Results: Psych/SA recidivism risk factors included: home visit duration fewer than four years (RR = 2.86, p = .0002), minority status (RR = 1.94, p = .0273), and schizophrenia diagnosis (RR = 1.79, p = .1056). Med/surg risk factors included: home visit duration fewer than four years and med/surg (RR = 3.88, p = .0055), residence in a facility having 80+ beds (RR = 1.97, p = .1103), and limited family contact (RR = 1.82, p = .1126). Conclusions: Minority status, schizophrenia diagnosis, and shorter time receiving CRC home visits were associated with increased psych/SA recidivism. Living in a larger board and care, having limited social contact with family, and shorter time receiving CRC home visits were associated with increased med/surg recidivism. Impact: Additional efforts may be warranted to reduce recidivism among minority, those with schizophrenia, residents of larger facilities, those isolated from family, and recently enrolled CRC patients