Academic journal article Hong Kong Journal of Psychiatry

Case Management in a Psychiatric Hospital: Review of Outcomes and Resource Utilisation

Academic journal article Hong Kong Journal of Psychiatry

Case Management in a Psychiatric Hospital: Review of Outcomes and Resource Utilisation

Article excerpt

Abstract

Objective: Case management is a heterogeneous concept used in psychiatry and other health, welfare, and service sectors. The several models of case management in psychiatry can be viewed as arising from task areas of psychiatric care, namely medical, rehabilitation, social control, growth, and development. This study investigated the development of the brokerage model of case management in acute psychiatric care in a psychiatric hospital.

Patients and Methods: 227 patients referred to the psychiatric case managers between November 2003 and October 2004 were included in this health service review. The psychiatric case managers maintained their own databases as well as recording information in the patients' medical records. The information from these databases was collated for review.

Results: There was a significant decrease in the number of hospital readmissions, following the introduction of case management from 65 to 26 (p = 0.001). There was a decrease in the number of patients who defaulted follow-up appointments from 24.0% for all outpatients to 11.9% for patients receiving case management (p = 0.001). The average number of days per admission was reduced from 15.6 days to 4 days (p = 0.001).

Conclusion: The cost-effectiveness of the case management service is reflected by the reduction in hospital readmission and duration of hospital stay.

Key words: Case management, Patient admission, Psychiatry

Introduction

Case management has been extensively studied in western countries. There has been debate about the effectiveness of psychiatric case management but recent meta-analyses have indicated effectiveness in various areas. (1,2) These areas include reduction in symptoms, reduced dropout rates, increased patient contact with services, improved social functioning, and reports of service satisfaction. There has been limited research on psychiatric case management in Asia and there are only a few reports of its efficacy and cost-effectiveness in Asian settings. (3) The Commission for Case Management Certification defines case management as a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs using communication and available resources to promote quality and cost-effective outcomes. (4)

The Institute of Mental Health, Woodbridge Hospital, Singapore, is a 2210-bed psychiatric hospital. The average bed occupancy is 1910 (from the average daily inpatient census taken from 1 August 2004 to 31 August 2004) and, together with general hospital psychiatric units, serves a population of 4.24 million. (5)

Case management was introduced in the hospital in 2000, first as part of an Early Psychosis Intervention Program and later for the general adult psychiatry service. The hospital's objective was to provide quality care that is comprehensive and effective for patients and to reduce the burden of chronic and severe mental illness on patients' families and society. Psychiatric patients in Singapore, similar to those in other countries, experience a wide range of debilitating psychiatric problems, inadequate social support, and multiple stressors. Community resources tend to be fragmented and are limited in some areas, for example, housing. A secondary objective was to use case management to expand and enhance community psychiatric services in Singapore.

Case management has been conceptualised in different ways. (6) Mueser et al described 6 models of case management as: brokerage, clinical, strength, rehabilitation, assertive community, and intensive. (7) For the service needs of the hospital, a brokerage model of case management was adopted. The brokerage model has sometimes been criticised for providing minimal direct service to patients. Despite this, the model was selected for its applicability to the hospital setting and it enabled services to be arranged from amongst those available in the community. …

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