Service components of case management that reduce in-patient care use

Eri Kuno, University of Pennsylvania

Abstract

Case management is expected to fill the gap between the needs of the seriously mentally ill and the care system. The findings from previous research on case management are inconsistent with respect to its impact on hospitalization, ambulatory service use, and clinical improvement. This study compared the effectiveness of two types of case management: traditional case management (CM) which included the function of service coordination, and Intensive Case Management (ICM) which consisted of both the coordination function and the provision of direct support to the client in the community. Secondary data on public clients using the Philadelphia mental health system were used. Clients selected for the study were Medicaid eligible adults, with a diagnosis of schizophrenia or affective disorder and had at least 60 inpatient days one year prior to the end of the inpatient episode. The ICM sample consisted of 80 clients who were linked to ICM immediately following discharge. The CM sample consisted of 84 clients who received CM instead of ICM while they waited for the registration for ICM. The demographic characteristics and the prior mental health service use patterns showed that the two groups had similar characteristics. Over the follow-up year, 65% of the ICM clients and 76% of the CM clients were rehospitalized. Among the clients who were rehospitalized, the time in the community prior to the rehospitalization was significantly longer for the ICM clients (M = 148, SD = 104) than for the CM clients (M = 94, SD = 93). There was no significant difference between the two groups in continuity of care variables. The ICM clients had significantly more contacts with case managers than the CM clients on average. These findings suggest that the connection to the existing mental health services is not a significant factor in explaining the difference in rehospitalization outcome between ICM and CM. It appears that the provision of non-treatment, direct support services may make a significant difference.

Subject Area

Social work|Mental health|Health care

Recommended Citation

Kuno, Eri, "Service components of case management that reduce in-patient care use" (1996). Dissertations available from ProQuest. AAI9627950.
https://repository.upenn.edu/dissertations/AAI9627950

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