Use of Rn Case Management and Costs and Utilization of Outpatient Mental Health Services: A Pilot Study

Abstract

The majority of outcome studies on case management seem to have been studied on the chronically mentally ill patients. Little is known regarding the use of a case management approach with general psychiatric populations, which include non-chronically mentally ill patients in an outpatient setting. This study examined the effect of a registered nurse case management (RNCM) model on the delivery and cost of mental health services during an 18-month period for clients in an outpatient psychiatric setting. Sixty clients met the criteria for sample selection. The data indicated that the use of the RNCM model resulted in more nursing than psychiatric care. Despite more frequent visits to the RNCM and longer RNCM visits, RNCM services appeared cost effective and were related to decreased length of hospital stay. A subgroup of high-risk clients was identified, and a significantly greater use of services by this group was substantiated.

Strategies for utilisation management of hospital services: a systematic review of interventions

“…Included studies were published between 1982 and 2020, conducted mostly in the USA ( n = 34) [ 22 – 24 , 29 – 32 , 37 , 39 , 40 , 42 , 43 , 45 , 47 , 49 , 56 , 57 , 60 , 63 , 65 , 67 – 71 , 73 – 75 , 77 , 78 , 81 , 82 , 84 , 85 ], Canada ( n = 4) [ 26 , 35 , 55 , 61 ], Australia (n = 4) [ 38 , 41 , 59 , 83 ], UK ( n = 3) [ 36 , 64 , 72 ], Sweden ( n = 3) [ 62 , 66 , 76 ], and one each in the Netherlands [ 52 ], Korea [ 44 ], China [ 53 ], Taiwan [ 27 ], Singapore [ 54 ], and Bahrain [ 34 ]. All studies focused on the general adult population; however, some focused on specific broader subgroups with psychiatric problems [ 29 , 45 , 54 , 83 ], comorbid conditions [ 49 , 77 ], psychosocial problems (e.g., problems with housing, medical care, substance abuse, mental health disorders, or financial entitlements) [ 70 ], uninsured [ 30 , 31 , 43 , 68 ], patients with chronic medical conditions [ 27 , 46 , ...…”

“…Fourteen studies (21.9%) were randomized controlled trials [ 22 , 23 , 43 , 47 , 49 , 52 , 53 , 55 , 62 , 66 , 69 , 70 , 73 , 74 ], three were multicenter research trials [ 36 , 63 , 76 ], two were quasi-experimental studies [ 31 , 67 ], four were controlled before-and-after studies [ 30 , 68 , 72 , 85 ], twenty-one studies (32.8%) were non-controlled before-and-after studies (NCBA) [ 24 , 27 – 29 , 32 , 35 , 37 – 39 , 41 , 42 , 50 , 54 , 56 – 61 , 75 , 78 ], three were time-series studies [ 26 , 34 , 44 ], three were case-control studies [ 64 , 65 , 84 ], one was a prospective cohort study [ 77 ], one was longitudinal study, six were retrospective cohort studies [ 25 , 33 , 79 – 82 ], and four were cross-sectional studies [ 40 , 45 , 71 , 83 ]. While, in two studies were not stated type of design [ 48 , 51 ].…”

“…While, in two studies were not stated type of design [ 48 , 51 ]. Fourty studies (59.7%) can be categorized as assessing interventions targeted at the patient journey during hospital stay or medical center-based interventions [ 22 – 24 , 26 , 27 , 29 , 30 , 34 , 37 , 39 , 40 , 42 , 44 , 45 , 49 , 54 , 56 , 57 , 59 – 63 , 65 , 69 , 70 , 72 , 74 , 75 , 78 , 81 – 83 , 85 ]; four evaluated interventions aimed at discharge [ 41 , 47 , 55 , 76 ], Not; and 13 examined community-based interventions [ 31 , 35 , 38 , 43 , 46 , 52 , 53 , 64 , 66 – 68 , 73 , 77 ].…”

“…of inpatient procedure – 452 – – 466 14 No No. of admission per 1000 patients 625.4 641.8 16.4 No Adjusted LOS – 5.9 – – 6.1 0.2 No Adjusted ALOS, mean – 5.8 – – 6.1 0.3 No Jambunathan et al [ 45 ] (1995) the United States Case management No. of case management visits/Adjusted LOS (r-value) – – – – .6138 – Yes Williams et al [ 83 ] (1994) Australia Drug utilisation review No.…”

“…Eight studies focused on using case management interventions based outside the hospital. Five studies reported a decrease in hospital utilisation [ 45 , 46 , 64 , 66 ]. Three studies found no significant difference between groups in neither ED visits nor hospital admissions [ 43 , 67 , 73 ].…”