Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, 12340University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Management, Policy, and Community Health, School of Public Health, 12340University of Texas Health Science Center at Houston, Houston, TX, USA.
Inquiry. 2021 Jan-Dec;58:469580211049030. doi: 10.1177/00469580211049030.
High-need, high-cost patients include those with diagnosed serious mental illnesses (e.g., schizophrenia; SMI). They often delay or fail to seek treatment. If they receive treatment, care is often sought from generalist settings (e.g., primary care or emergency medicine) or is suboptimal due to the provision of limited, non-evidence-based intervention and lack of communication, integration, and coordination among providers. This results in high aggregate costs and poor outcomes. Value-based health care requires care coordination to address the medical and social needs of this population. We describe a unique early intervention program for SMI that emanates from an inpatient setting: The Early Onset Treatment Program (EOTP) at the University of Texas Health Science Center at Houston-Harris County Psychiatric Center. The EOTP offers free, phase-specific, multidisciplinary treatment to young adults without health insurance with the aim of improving their long-term outcomes and reducing the rate of rehospitalization. An evaluation of the EOTP indicates program participants were significantly less likely to be rehospitalized at six months (4.73 times less likely) and at 12 months (3.5 times less likely) than a comparison group ( <.001), and participants' scores of symptomatology and disability significantly decreased following treatment.
高需求、高花费患者包括那些被诊断出患有严重精神疾病(例如精神分裂症;SMI)的患者。他们往往会延迟或拒绝寻求治疗。如果他们接受治疗,通常会在综合医疗机构(例如初级保健或急诊医学)寻求治疗,或者由于提供有限的、非基于证据的干预措施以及提供者之间缺乏沟通、整合和协调,导致治疗效果不佳。这导致总体费用高且治疗效果差。基于价值的医疗保健需要进行护理协调,以满足这部分人群的医疗和社会需求。我们描述了一种源自住院环境的针对 SMI 的独特早期干预计划:休斯顿-哈里斯县精神卫生中心德克萨斯大学健康科学中心的早期干预治疗计划(EOTP)。EOTP 为没有医疗保险的年轻成年人提供免费的、特定阶段的、多学科的治疗,旨在改善他们的长期预后并降低再住院率。对 EOTP 的评估表明,与对照组相比,计划参与者在六个月(可能性低 4.73 倍)和十二个月(可能性低 3.5 倍)时再次住院的可能性显著降低(<0.001),且参与者的症状和残疾评分在治疗后显著下降。