Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis).
Psychiatr Serv. 2022 Oct 1;73(10):1109-1116. doi: 10.1176/appi.ps.202100197. Epub 2022 May 11.
Among veterans with posttraumatic stress disorder (PTSD), supported employment that utilizes the individual placement and support (IPS) model has resulted in consistently better employment and functional outcomes than usual vocational rehabilitation services. This study aimed to compare these two approaches in terms of health services use and associated costs.
A secondary analysis of a multisite randomized controlled trial of 541 unemployed veterans with PTSD used archival data from electronic medical records to assess the use and costs of health services of IPS and usual care (i.e., a transitional work [TW] program) over 18 months. Comparisons were also made to an 18-month postintervention period.
The two study groups did not differ in number of inpatient days or in utilization or cost of high-intensity services. Annual per-person costs of health services were approximately 20% higher for IPS than for TW participants (mean difference=$4,910 per person per year, p<0.05) during the intervention period, largely driven by higher utilization and costs for vocational services in the IPS group (p<0.001). These costs declined postintervention to nonsignificant differences. The mean annual per-person vocational service cost was $6,388 for IPS and $2,549 for TW (mean difference=$3,839, p<0.001) during the intervention period.
In keeping with IPS’s intensive case management approach, veterans receiving IPS used more vocational services and had correspondingly higher costs than veterans receiving TW. The two groups did not differ in use or cost of other types of health services. Future research should examine whether higher short-term costs associated with IPS relative to usual care result in long-term cost savings or higher quality of life for persons with PTSD.
在患有创伤后应激障碍（PTSD）的退伍军人中，采用个体安置和支持（IPS）模式的支持性就业已导致就业和功能结果明显优于常规职业康复服务。本研究旨在比较这两种方法在卫生服务利用和相关成本方面的差异。
对 541 名患有 PTSD 的失业退伍军人进行的一项多地点随机对照试验的二次分析，利用电子病历中的档案数据评估 IPS 和常规护理（即过渡性工作 [TW] 计划）在 18 个月内的卫生服务利用和成本。还与干预后 18 个月进行了比较。
两组在住院天数或高强度服务的利用和成本方面没有差异。在干预期间，IPS 组比 TW 组每人每年的健康服务费用高出约 20%（人均差异为$4910 美元/人/年，p<0.05），主要是由于 IPS 组职业服务的利用和成本较高（p<0.001）。这些成本在干预后下降到无统计学意义的差异。在干预期间，IPS 组每人每年的职业服务平均费用为$6388，TW 组为$2549（人均差异为$3839，p<0.001）。
与 IPS 的强化个案管理方法一致，接受 IPS 的退伍军人比接受 TW 的退伍军人使用更多的职业服务，相应的费用也更高。两组在其他类型的卫生服务的利用和成本方面没有差异。未来的研究应探讨 IPS 相对于常规护理的较高短期成本是否会导致 PTSD 患者的长期成本节约或更高的生活质量。
