Psychiatric inpatient cost of care before and after admission at a residential subacute step-up/step-down mental health facility

Abstract

Background: Residential step-up/step-down services provide transitional care and reintegration into the community for individuals experiencing episodes of subacute mental illness. This study aims to examine psychiatric inpatient admissions, length of stay, and per capita cost of care following the establishment of a step-up/step-down Prevention And Recovery Care (PARC) facility in regional Australia.

Methods: This was a pragmatic before and after study set within a participatory action research methodology. The target sample comprised patients at a PARC facility over 15 months. Six-month individual level data prior to study entry, during, and over 6-months from study exit were examined using patient activity records. Costs were expressed in 2015–2016AU$.

Results: An audit included 192 people experiencing 243 episodes of care represented by males (58%), mean age = 39.3 years (SD = 12.7), primarily diagnosed with schizophrenia (48%) or mood disorders (30%). The cost of 1 day in a psychiatric inpatient unit was found to be comparable to an average of 5 treatment days in PARC; the mean cost difference per-bed day (AU$1,167) was associated with fewer and shorter inpatient stays. Reduced use of inpatient facility translated into an opportunity cost of improved patient flow equivalent to AU$12,555 per resident (bootstrapped 95% CI = $5,680–$19,280). More noticeable outcomes were observed among those who stayed in PARC for longer during index admission (r_s = 0.16, p = 0.024), who have had more and lengthy inpatient stays (r_s = 0.52, p < 0.001 and r_s = 0.69, p < 0.001), and those who stepped-down from the hospital (p < 0.001). This information could be proactively used within step-up/step-down services to target care to patients most likely to benefit. Despite early evidence of positive association, the results warrant further investigation using an experimental study design with alongside economic evaluation.

Conclusion: Efforts should be directed toward the adoption of cost-effective alternatives to psychiatric inpatient facilities that provide comparable or improved patient outcomes.

Keywords:

• Community mental healthcare
• hospital avoidance
• evidence-informed practice
• evaluation
• cost-offset

JEL classification codes:

• D61
• C12

Transparency

Declaration of funding

This project was supported by Mind Australia and CQUniversity SHHSS Engaged Research Grant.

Declaration of financial/other relationships

JJ and TW are employees of Mind Australia. The authors report no additional competing interests. The findings and conclusions presented in this manuscript are those of the authors and do not necessarily represent the views of Mind Australia or CHHHS. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Acknowledgements

The authors would like to acknowledge NHMRC Centre for Research Excellence in Integrated Quality Improvement and Cairns and Hinterland Health and Hospital Service (CHHHS) for in-kind support. We deeply appreciate the considerable support, commitment, and contributions of the Cairns PARC team. We acknowledge the following individuals for their contribution to this project: Jade Varcoe, Joe Petrucci, Steve Morton, Catherine Sharpe, John Weaver, Denise Cumming, Heather Thompson, and Margaret Grigg. We thank Lisa Brophy for helpful comments.