Impact of Illness Management and Recovery Programs on Hospital and Emergency Room Use by Medicaid Enrollees

Abstract

Objective Illness management and recovery is a structured program that helps consumers with severe mental illness learn effective ways to manage illness and pursue recovery goals. This study examined the impact of the program on health service utilization. Methods This was a retrospective cohort study of five assertive community treatment (ACT) teams in Indiana that implemented illness management and recovery. With Medicaid claims data from July 1, 2003, to June 30, 2008, panel data were created with person-months as the level of analysis, resulting in 14,261 observations, for a total of 498 unique individuals. Zero-inflated negative binomial regression models were used to predict hospitalization days and emergency room visits, including covariates of demographic characteristics, employment status, psychiatric diagnosis, and concurrent substance use disorder. The main predictor variables of interest were receipt of illness management and recovery services, dropout from the program, and program graduation status. Results Consumers who received some illness management and recovery services had fewer hospitalization days than those receiving only ACT. Graduates had fewer emergency room visits than did ACT-only consumers. Conclusions This is the first study to examine the impact of illness management and recovery on service utilization. Controlling for a number of background variables, the study showed that illness management and recovery programs were associated with reduced inpatient hospitalization and emergency room use over and above ACT.

Comparative impact of professional mental health background on ratings of consumer outcome and fidelity in an illness management and recovery program.

“…The findings demonstrate the superiority of IMR over TAU, replicating prior research (e.g., Fujita et al, 2010;Hasson-Ohayon et al, 2007;Levitt et al, 2009;Salyers, Rollins, Clendenning, McGuire, & Kim, 2011). It is interesting that no significant differences were found in consumers' outcome regardless if the practitioner was a professional, paraprofessional, or a peer provider.…”

Reviewing Illness Self-Management Programs: A Selection Guide for Consumers, Practitioners, and Administrators

“…The most widely researched of the five programs is IMR (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Like WRAP, several studies included researchers who were also involved in the development of the program.…”

“…The two other studies that utilized quasi-experimental designs lacked rigor in identifying comparison groups, contributing to methodological weaknesses that diminished confidence in internal validity (37,40). The retrospective study limited outcomes to hospitalization rates and emergency department visits, with no reports on recovery-related outcomes (49).…”

The Relationship of Illness Management and Recovery to State Hospital Readmission

“…IMR has been broadly implemented nationally including in state psychiatric hospitals (Bartholomew and Kensler, 2009;Gingerich and Mueser, 2011). Previous work has shown that IMR is associated with reducing the number and length of hospitalizations when provided by assertive community treatment teams (Salyers et al, 2009). The IMR program offered in community settings has been shown to significantly improve a person's knowledge of one's illness, identification of goals, clinician perception of client recovery (Hasson-Ohayon et al, 2007), illness self-management, psychosocial functioning, overall improvement of self-reported symptoms, as well as improvement in levels of depression and anxiety (Levitt et al, 2009).…”