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Service Use and Cost in 2002 Among Clients in Community Settings Who Were Discharged From a State Hospital in 1989

OBJECTIVE: This analysis is a follow-up of a 1992 study of service use and cost of care among patients discharged from a state hospital. This study documented utilization and cost of care in 2002. METHODS: Study participants were 150 former long-stay patients who were discharged from a state psychiatric hospital in 1989. An integrated database of all mental health and medical services reimbursed by Medicaid and Medicare as well as state- and county-funded services was used to construct descriptive statistics on service use and unit cost measures. Data on mortality, homelessness and criminal arrests were obtained from vital statistics, jail records and shelter admissions. RESULTS: During 2002, 18% of study participants had a psychiatric hospital admission, with a mean length of stay of 60 days. Almost all participants (99%) received some form of outpatient mental health care, and 66% were living in publicly funded residential housing. The total annual cost per study participant for the 2002 service package was $89,699. Residential care accounted for 54% of the total cost. Between 1989 and 2005, 3% were admitted to county jails and 9% had experienced homelessness. Of the original discharged sample of 590 patients, 37% died between 1989 and 2002; the mean age at death was 63±15 years. CONCLUSIONS: This analysis suggests that individuals discharged from state psychiatric institutions have been integrated into community residential settings and are receiving psychiatric outpatient treatment on a regular basis. Cost estimates, using the consumer price index for 2002, were $78,773 in 1992 compared with $85,850 for the exact same service package in 2002.

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