Impact of efforts to reduce inpatient costs on clinical effectiveness: treatment of posttraumatic stress disorder in the Department of Veterans Affairs.

BACKGROUND

There have been major reductions in the availability of inpatient psychiatric care in the United States in recent years.

OBJECTIVE

The objective of this study was to evaluate the clinical impact of cost-cutting changes in the delivery of inpatient psychiatric care.

DESIGN

This was a nonequivalent control group pre/post design.

SUBJECTS

Outcome data on 6,397 veterans treated between 1993 and 2000 at 35 specialized VA inpatient and residential programs for posttraumatic stress disorder (PTSD) were used to compare changes in effectiveness (measured as patient improvement from admission to 4 months after discharge) at programs that either shortened their average length of stay or converted from a hospital-based program to a low-cost residential rehabilitation program. For comparison, outcome data are also presented over the same years from both inpatient PTSD programs and residential PTSD programs that did not experience program change.

MEASURES

Measures addressed baseline characteristics and 4-month postdischarge outcome measures of PTSD symptoms, substance abuse, violent behavior, and employment.

RESULTS

Analyses of covariance showed no significant change in outcomes at inpatient programs that either reduced their length of stay or did not change at all. However, effectiveness declined on some measures at inpatient programs that converted to residential treatment during this period but improved at residential treatment programs that had been established before this period of change.

CONCLUSIONS

Although there was no deterioration in effectiveness related to reduced length of inpatient stay, programs that converted to a residential model showed decreased effectiveness.