4.5 Article

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England

Journal

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY
Volume 31, Issue 11, Pages 1208-1216

Publisher

WILEY
DOI: 10.1002/gps.4424

Keywords

integrated care; costs; admissions; multidisciplinary teams; social work

Funding

  1. National Institute for Health Research (NIHR), under its Programme Grants for Applied Research programme [RP-PG-0606-1109]
  2. NIHR Doctoral Research Fellowship of Mark Wilberforce [DRF-2013-06-038]
  3. National Institute for Health Research [RP-PG-0606-1109, DRF-2013-06-038] Funding Source: researchfish
  4. National Institutes of Health Research (NIHR) [DRF-2013-06-038] Funding Source: National Institutes of Health Research (NIHR)

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Objectives: To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission. Methods: An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission. Results: Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types. Conclusions: Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures. (C) 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

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