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

TY - JOUR

T1 - 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

AU - Wilberforce, Mark

AU - Tucker, Sue

AU - Brand, Christian

AU - Abendstern, Michele

AU - Challis, David

AU - Jasper, Rowan Elaine

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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.

AB - 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.

KW - admissions

KW - costs

KW - integrated care

KW - multidisciplinary teams

KW - social work

UR - http://www.scopus.com/inward/record.url?scp=84957544607&partnerID=8YFLogxK

U2 - 10.1002/gps.4424

DO - 10.1002/gps.4424

M3 - Article

C2 - 26833970

AN - SCOPUS:84957544607

SN - 0885-6230

VL - 31

SP - 1208

EP - 1216

JO - International journal of geriatric psychiatry

JF - International journal of geriatric psychiatry

IS - 11

ER -