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Articles   |    
Full-Service Partnerships Among Adults With Serious Mental Illness in California: Impact on Utilization and Costs
Todd P. Gilmer, Ph.D.; Ana Stefancic, M.A.; Sam Tsemberis, Ph.D.; Susan L. Ettner, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300380
View Author and Article Information

Dr. Gilmer is with the Department of Family and Preventive Medicine, University of California, San Diego (e-mail: tgilmer@ucsd.edu). Ms. Stefancic and Dr. Tsemberis are with Pathways to Housing, Inc., New York City. Ms. Stefancic is also with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City. Dr. Ettner is with the David Geffen School of Medicine and the Department of Health Services, University of California, Los Angeles. Preliminary results related to this work were presented at the Housing First Partners Research Conference, March 2012, New Orleans; the AcademyHealth Annual Research Meeting, June 2012, Orlando; and the Agency for Healthcare Research and Quality annual meeting, September 2012, Washington, D.C.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  California’s full-service partnerships (FSPs) provide a combination of subsidized permanent housing and multidisciplinary team–based services with a focus on rehabilitation and recovery. The goal of the study was to examine whether participation in FSPs is associated with changes in health service use and costs compared with usual care.

Methods  A quasi-experimental, pre-post, intent-to-treat design with a propensity score–matched contemporaneous control group was used to compare health service use and costs among 10,231 FSP clients and 10,231 matched clients with serious mental illness who were receiving public mental health services in California from January 1, 2004, through June 30, 2010.

Results  Among FSP participants, the mean annual number of mental health outpatient visits increased by 55.5, and annual mental health costs increased by $11,725 relative to the matched control group. Total service costs increased by $12,056.

Conclusions  Participation in an FSP was associated with increases in outpatient visits and their associated costs. As supportive housing programs are implemented nationally and on a large scale, these programs will likely need to be more effectively designed and targeted in order to achieve reductions in costly inpatient services.

Abstract Teaser
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Table 1Characteristics of clients in full-service partnerships (FSPs) and a propensity score–matched control group
Table Footer Note

a Nearest-neighbor matched with FSP clients on the basis of age, gender, race-ethnicity, clinical diagnosis, Medicaid coverage, service utilization in the preenrollment period, and county of residence. There were no statistically significant differences between the groups.

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Table 2Standardized utilization estimates for full-service partnership (FSP) participants one year pre- and postenrollment and for a propensity score–matched control groupa
Table Footer Note

a N=20,462. Standardized estimates were calculated with negative binomial regression models that adjusted for age, gender, race-ethnicity, clinical diagnosis, insurance coverage, and participation in the FSP. Standard errors were calculated using the nonparametric bootstrap, and p values were calculated with the percentile method, with 1,000 replications.

Table Footer Note

b For general medical or psychiatric stay

Anchor for Jump
Table 3Standardized cost estimates for full-service partnership (FSP) participants one year pre- and postenrollment and for a propensity score–matched control groupa
Table Footer Note

a N=20,462. Standardized estimates (in dollars) were calculated with two-part regression models that adjusted for age, gender, race-ethnicity, clinical diagnosis, insurance coverage, and participation in the FSP. Standard errors were calculated with the nonparametric bootstrap, and p values were calculated with the percentile method, with 1,000 replications.

Table Footer Note

b For general medical or psychiatric stay

Anchor for Jump
Table 4Standardized difference-in-difference (DID) cost estimates, stratified by county, for full-service partnership (FSP) participants one year pre- and postenrollment and for a propensity score–matched control groupa
Table Footer Note

a Standardized estimates (in dollars) were calculated with two-part regression models that adjusted for age, gender, race-ethnicity, clinical diagnosis, insurance coverage, and participation in the FSP. Standard errors were calculated with the nonparametric bootstrap, and p values were calculated with the percentile method, with 1,000 replications.

Table Footer Note

b For general medical or psychiatric stay

Table Footer Note

*p<.05, **p<.001

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