scholarly journals Cost-effectiveness of intensive v. standard case management for severe psychotic illness

2000 ◽  
Vol 176 (6) ◽  
pp. 537-543 ◽  
Author(s):  
◽  
Sarah Byford ◽  
Matthew Fiander ◽  
David J. Torgerson ◽  
Julie A. Barber ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Case Management ◽  
Hospital Admissions ◽  
Intensive Case Management ◽  
Standard Case ◽  
Severely Mentally Ill ◽  
Significant Difference ◽  
African Caribbean ◽  
Standard Case Management ◽  
The Cost

BackgroundIntensive case management is commonly advocated for the care of the severely mentally ill, but evidence of its cost-effectiveness is lacking.AimsTo investigate the cost-effectiveness of intensive compared with standard case management for patients with severe psychosis.Method708 patients with psychosis and a history of repeated hospital admissions were randomly allocated to standard (case-loads 30–35) or intensive (case-loads 10–15) case management. Clinical and resource use data were assessed over two years.ResultsNo statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patient (means £24 550 and £22 700, respectively, difference £1850, 95% Cl – £1600 to £5300). There was no evidence of differential effects in African–Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the randomised groups.ConclusionReduced case-loads have no clear beneficial effect on costs, clinical outcome or cost-effectiveness. The policy of advocating intensive case management for patients with severe psychosis is not supported by these results.

Comparison of intensive and standard case management for patients with psychosis

1999 ◽  
Vol 174 (1) ◽  
pp. 74-78 ◽  
Author(s):  
Francis Creed ◽  
Tom Burns ◽  
Tom Butler ◽  
Sarah Byford ◽  
Robin Murray ◽  
...  
Keyword(s):  
Case Management ◽  
Controlled Trial ◽  
Outcome Data ◽  
Cost Of Care ◽  
Intensive Case Management ◽  
Standard Case ◽  
Case Load ◽  
African Caribbean ◽  
Randomised Controlled ◽  
Standard Case Management

BackgroundCase management, particularly in intensive form, has been widely introduced for the treatment of severe mental illness. However, the optimal intensity of case management has not been determined.AimsWe aimed to assess whether intensive case management (small case load) reduces hospitalisation and costs compared with standard case management.MethodDevelopment and rationale of a large randomised controlled trial comparing intensive case management (case load per worker? 15 patients) with standard case management (case load 30–35 patients)ResultsTwo-year outcome data will be obtained on patients representative of the seriously mentally ill in inner-city mental health services.ConclusionsThe study planned with 700 patients should be sufficient to detect small differences in the readmission of patients to hospital (10%), the number of days spent in hospital over a two-year period (10 days) and the average weekly cost of care per patient. The sample is large enough to compare the cost-effectiveness of intensive and standard case management in mild and severe disability and in people of African–Caribbean origin and White Caucasians.

scholarly journals Suicidal behaviour in psychosis: Prevalence and predictors from a randomised controlled trial of case management

2001 ◽  
Vol 178 (3) ◽  
pp. 255-260 ◽  
Author(s):  
Elizabeth Walsh ◽  
Kate Harvey ◽  
Ian White ◽  
Anna Higgitt ◽  
Janelle Fraser ◽  
...  
Keyword(s):  
Case Management ◽  
Suicidal Behaviour ◽  
Standard Care ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Intensive Case Management ◽  
Treatment Groups ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Chronic Psychosis

BackgroundIt is unclear whether intensive case management influences the prevalence of suicidal behaviour in patients with psychosis.AimsTo compare the effect of intensive case management and standard care on prevalence of suicidal behaviour in patients with chronic psychosis.MethodPatients with established psychosis (n=708) were randomised either to intensive case management or to standard care. The prevalence of suicidal behaviour was estimated at 2-year follow-up and compared between treatment groups. Suicide attempters and non-attempters were compared on multiple socio-demographic and clinical variables to identify predictors of suicidal behaviour.ResultsThere was no significant difference in prevalence of suicidal behaviour between treatment groups. Recent attempts at suicide and multiple recent hospital admissions best predicted future attempts.ConclusionsIntensive case management does not appear to influence the prevalence of suicidal behaviour in chronic psychosis. Predictors identified in this study confirm some previous findings.

scholarly journals Assessing the value of assertive outreach

2003 ◽  
Vol 183 (5) ◽  
pp. 437-445 ◽  
Author(s):  
Tim Weaver ◽  
Peter Tyrer ◽  
Jane Ritchie ◽  
Adrian Renton
Keyword(s):  
Case Management ◽  
Social Care ◽  
Complex Interventions ◽  
Intensive Case Management ◽  
Standard Case ◽  
Psychiatric Emergencies ◽  
Assertive Outreach ◽  
Standard Case Management ◽  
Organisational Factors ◽  
The Impact

BackgroundIt is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial.AimsTo investigate outcome generation in the UK700 trial.MethodA qualitative investigation was undertaken in one UK700 centre.ResultsBoth intensive and standard case management practised individual casework, employed assertive outreach with comparable frequency, and performed similarly in the out-patient management of emergencies and inpatient discharge. However, ICM was advantaged in managing some noncompliance and undertaking casework that prevented psychiatric emergencies. Absence of team-based management and bureaucratised access to social care limited the impact of these differences on outcomes and the effective practice of assertive outreach, although this was relevant to only a sub-population of patients.ConclusionsThe impact of ICM was undermined by organisational factors. Sensitive anticipatory casework, which prevents psychiatric emergencies, may make ICM more effective than an exclusive focus on assertive outreach. Our findings demonstrate the value of qualitative research in evaluating complex interventions.

Systematic Review of Case Management

2007 ◽  
Vol 41 (1) ◽  
pp. 2-9 ◽  
Author(s):  
Lucinda Smith ◽  
Richard Newton
Keyword(s):  
Case Management ◽  
Assertive Community Treatment ◽  
Independent Living ◽  
Community Treatment ◽  
Intensive Case Management ◽  
Standard Case ◽  
Clinical Criteria ◽  
Current State ◽  
Standard Case Management ◽  
Experimental Trials

The purpose of the present paper was to review the current state of evidence for types of case management, focusing on the last 10 years since publication of the Cochrane Systematic Reviews of case management and assertive community treatment. A literature review of electronic databases from 1995 to the present to identify recent research on psychiatric case management, both original studies and reviews, was carried out. Original articles were organized on basis of year of study, experimental group and outcome variables to determine patterns. Sixty relevant papers were located. Thirty-nine are reports of experimental trials of types of case management and 21 are reviews or discussion papers. The focus of research is on assertive community treatment or intensive case management, with only five papers on other forms of less intense case management. Numerous outcomes have been examined, of those examined often enough to draw meaningful conclusions only one, engagement with services, has been consistently positive. All other outcomes have produced mixed results. The strength of findings in favour of case management has weakened over time. A heterogeneous group of experimental designs limits comparisons. Numerous issues with methodology and definitions of types of case management have beset research in this field. Assertive types of case management (including assertive community treatment and intensive case management) are more effective than standard case management in reducing total number of days spent in hospital, improving engagement, compliance, independent living and patient satisfaction. More important than the type of service configuration is to understand the clinical criteria of the services provided and their effectiveness.

Personality abnormality in severe mental illness and its influence on outcome of intensive and standard case management: a randomised controlled trial

2000 ◽  
Vol 15 (S1) ◽  
pp. 7-10 ◽  
Author(s):  
P. Tyrer ◽  
C. Manley ◽  
E. Van Horn ◽  
D. Leddy ◽  
O.C. Ukoumunne
Keyword(s):  
Personality Disorder ◽  
Case Management ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Intensive Case Management ◽  
Psychotic Illness ◽  
Standard Case ◽  
Weak Evidence ◽  
Randomised Controlled ◽  
Standard Case Management

SummaryOne hundred fifty-five (77%) of 201 participants recruited in a trial of intensive vs standard case management of patients with recurrent psychotic illness had their personality status measured before treatment and were followed up for two years. The primary outcome was the total number of days spent in psychiatric hospitalisation in the two years following randomisation. Thirty-three (21%) of the patients had a personality disorder and their duration of hospital stay (105 days) was greater than in those without personality disorder (56 days). There was weak evidence that intensive case management more effective in reducing the duration of care in those with personality disorder than in those without personality disorder.

scholarly journals Cost-Effectiveness of Initial Revision Digit Amputation Performed in the Emergency Department Versus the Operating Room

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Joseph A. Gil ◽  
Avi D. Goodman ◽  
Andrew P. Harris ◽  
Neill Y. Li ◽  
Arnold-Peter C. Weiss
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Operating Room ◽  
Cost Effective ◽  
Initial Management ◽  
Fingertip Amputation ◽  
Significant Difference ◽  
Initial Procedure ◽  
The Cost ◽  
Cost Effectiveness Threshold

Background: The objective of this study was to determine the comparative cost-effectiveness of performing initial revision finger amputation in the emergency department (ED) versus in the operating room (OR) accounting for need for unplanned secondary revision in the OR. Methods: We retrospectively examined patients presenting to the ED with traumatic finger and thumb amputations from January 2010 to December 2015. Only those treated with primarily revision amputation were included. Following initial management, the need for unplanned reoperation was assessed and associated with setting of initial management. A sensitivity analysis was used to determine the cost-effectiveness threshold for initial management in the ED versus the OR. Results: Five hundred thirty-seven patients had 677 fingertip amputations, of whom 91 digits were initially primarily revised in the OR, and 586 digits were primarily revised in the ED. Following initial revision, 91 digits required unplanned secondary revision. The unplanned secondary revision rates were similar between settings: 13.7% digits from the ED and 12.1% of digits from the OR ( P = .57). When accounting for direct costs, an incidence of unplanned revision above 77.0% after initial revision fingertip amputation in the ED would make initial revision fingertip amputation in the OR cost-effective. Therefore, based on the unplanned secondary revision rate, initial management in the ED is more cost-effective than in the OR. Conclusions: There is no significant difference in the incidence of unplanned/secondary revision of fingertip amputation rate after the initial procedure was performed in the ED versus the OR.

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