MENTAL HEALTH SERVICE UTILIZATION PATTERNS IN PATIENTS ADMITTED TO THE FOCUS INTENSIVE OUTPATIENT TREATMENT PROGRAM AT GRADY HEALTH SYSTEM 公开

Abstract

Abstract
MENTAL HEALTH SERVICE UTILIZATION PATTERNS IN PATIENTS
ADMITTED TO THE FOCUS INTENSIVE OUTPATIENT TREATMENT PROGRAM
AT GRADY HEALTH SYSTEM

BY
Karen Michele Hochman

Objective: This study examines mental health service use in a cohort of severely
mentally ill patients admitted to an acute partial hospitalization program ("FOCUS")
between November, 2004 and December, 2007. Service use in the twelve months before
and after admission was examined. Service use data were then compared for program
completers and non-completers.

Methods: The FOCUS intervention was designed for adults aged 18-64 who are
suffering from one or more Axis I disorders accompanied by severe impairment.
Treatment included: psychiatric assessment, nursing/medical screening,
pharmacotherapy, group, family and individual therapies, and case management.
Programming was for five hours/day, five days a week. Data for 215 admissions were
examined for one year before and after admission to the program. T-tests were used to
compare service use before and after the intervention, and between completers and non-
completers.

Results: The mean duration of treatment was 52 days for program completers and 26
days for non-completers. There was a significant decline in inpatient days before and
after the intervention (19.0 days vs. 5.1 days, p<0.001), with no significant change in
Psych ER visits (1.6 visits vs. 1.5 visits, p=0.454). There were three times more non-
urgent mental health visits (not including FOCUS visits) in the twelve months after
admission to the program than before (3.9 vs. 11.7, p<0.001); furthermore, completers
attended three times as many non-urgent outpatient visits (not including FOCUS visits)
as non-completers (14.4 vs. 5.1, p<0.001).

Conclusions: The intervention was associated with a decrease in inpatient days but not
ER visits. Results are limited by the pre-post study design and our inability to control for
potential unmeasured confounders. Further research is needed in order to determine
whether acute partial hospitalization in a population with high disease burden and other
determinants of disproportionately low mental health service use might improve
outcomes and enhance adaptive service use.

Table of Contents

7
TABLE OF CONTENTS
ACKNOWLEDGEMENTS ................................................................................................ 6
LIST OF TABLES .............................................................................................................. 8
MENTAL HEALTH SERVICE UTILIZATION PATTERNS IN PATIENTS
ADMITTED TO THE FOCUS INTENSIVE DAY TREATMENT PROGRAM AT
GRADY HEALTH SYSTEM............................................................................................. 9
Methods ................................................................................................................ 18
Study Design: ........................................................................................................ 18
Sample size : .............................................................................................. 18
Human Subjects and Confidentiality issues: ........................................ 19
Informed consent: ..................................................................................... 20
IRB approval: ............................................................................................ 20
Results .................................................................................................................. 22
Discussion............................................................................................................. 27
CONCLUSION; STUDY IMPLICATIONS AND FUTURE DIRECTIONS ................. 34
REFERENCES ................................................................................................................. 36
APPENDICES .................................................................................................................. 38

8
LIST OF TABLES
PSYCHIATRIC EMERGENCY SERVICE VISITS .................................................. 52
NUMBER OF PSYCHIATRIC INPATIENT ADMISSIONS .................................... 51
NUMBER OF PSYCHIATRIC INPATIENT ADMISSIONS (CONT'D) ................ 55
NUMBER OF PSYCHIATRIC INPATIENT DAYS .................................................. 56
NUMBER OF PSYCHIATRIC INPATIENT DAYS (CONT'D) ............................... 57
NUMBER OF NON URGENT PSYCHIATRIC VISITS ........................................... 58
NUMBER OF NON URGENT PSYCHIATRIC VISITS (CONT'D) ........................ 59

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health
关键词	health outcomes day hospital partial hospitalization service utilization intensive outpatient treatment mental health
Committee Chair / Thesis Advisor	Druss, Benjamin G, Emory University
Committee Members	Barker, Nancy D, Emory University Ziemer, David Carleton, Emory University

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