Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison

Abstract

Objective: In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. Methods: We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care (‘PARCS consumers’) with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period (‘inpatient-only consumers’). We used routinely collected data to compare them on a range of outcomes. Results: Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. Conclusion: Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

Assessment of Psychological Recovery Using STORI-30

“…The characteristics of patients in our study were comparable to previous studies. (7)(8)(9) We noted patients presented commonly with earlier stages of recovery, i.e., moratorium and awareness, at admission to PARC. However, this changed around the time of discharge that more patients were in the advanced recovery stages, such as rebuilding and growth.…”

“…Studies generally show favourable clinical outcomes for patients admitted to PARC. (7)(8)(9) The main intake criterion for admission to PARC is motivation to participate in personal recovery. Patients can be admitted from inpatient units (step-down admission) or community mental health services (step-up admission).…”

Developing fit-for-purpose funding models for rural settings: Lessons from the evaluation of a step-up/step-down service in regional Australia

“…Despite its complexity, there is a growing body of literature that demonstrates the clinical and cost-effectiveness of the SUSD model ( 1 ). The evaluation of the growing SUSD sector in Australia has shown positive outcomes regarding quality of life, symptoms and functioning ( 4 , 7 , 13 – 15 ), progress toward achieving goals identified on the individual recovery plans ( 16 ), and consumer satisfaction with service delivery, relating to elements such as service approach and ethos, program activities, safety, and communal qualities and environment ( 7 , 14 , 17 , 18 ). Although more limited, there is also some encouraging evidence of the positive short-term impact on quality of life after discharge ( 15 ).…”

A perfected mismatch: Are prevention and recovery care services really comparable to acute inpatient units?

“…A recent matched pairs analysis of Prevention and Recovery Care Services (PARCS) concludes that they offer a less restrictive and cost-effective alternative to inpatient facilities for eligible patients (Farhall et al, 2021). This study explored whether PARCS recovery-orientated care model admissions led to better outcomes, i.e., less subsequent 24-hour care requirements and less Inpatient Treatment Orders (ITOs) or Community Treatment Orders (CTOs).…”

“…Farhall et al (2021) used propensity score matching (PSM), a method utilised to analyse an observational dataset by setting a priori selected matched variables approximating a randomised experiment. However, PSM has been criticised on the basis that it yields an experimental design with lower standards than necessary, through generating higher levels of imbalance, model dependence, and bias, as well as failing to use all the information available such as latent variables (King and Nielsen, 2019).…”