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Brief Reports   |    
A Case and Care Management Program to Reduce Use of Acute Care by Clients With Substance Use Disorders
Thomas A. Kirk, Ph.D.; Paul Di Leo, M.S., F.A.C.H.E.; Patricia Rehmer, M.S.N.; Samuel Moy, Ph.D.; Larry Davidson, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200258
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Dr. Kirk and Dr. Davidson are with the Department of Psychiatry, Yale University.
Mr. Di Leo and Ms. Rehmer are affiliated with the Connecticut Department of Mental Health and Addiction Services, Hartford.
Dr. Moy is with Advanced Behavioral Health, Middletown, Connecticut.
Send correspondence to Dr. Davidson at Yale Program for Recovery and Community Health, 319 Peck St., New Haven, CT 06513 (larry.davidson@yale.edu).

Copyright © 2013 by the American Psychiatric Association


Objective  The authors describe outcomes of a targeted case and care management program for persons with addictions utilizing a high level of acute services in Connecticut’s system of care.

Methods  Administrative and cost data were analyzed from five consecutive years (2004–2008) (N=165,305 clients).

Results  In the year after enrollment, acute care episodes fell by 56% compared with the year before enrollment, with a 19% increase in engagement in nonacute care services. Paid units of acute care fell by 62%; paid units of nonacute care increased by 63%. Costs of care were approximately 46% lower in the year after enrollment.

Conclusions  Findings suggest that outcomes can be improved while costs and acute care demands can be reduced through combined use of care management to identify high users and case management to engage them in lower levels of care. The system was able to reallocate acute care resources to nonacute services and serve additional clients.

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Figure 1 Number of high service users in the case and care management program, by fiscal year


Davidson  L;  White  W;  Sells  D  et al:  Enabling or engaging? The role of recovery support services in addiction recovery.  Alcoholism Treatment Quarterly 28:391–416, 2010
Hesse  M;  Vanderplasschen  W;  Rapp  RC  et al:  Case management for persons with substance use disorders: a review.  Cochrane Library of Systematic Reviews , 2007(2):CD006265
McLellan  AT;  Hagan  TA;  Levine  M  et al:  Does clinical case management improve outpatient addiction treatment?  Drug and Alcohol Dependence 55:91–103, 1999
[CrossRef] | [PubMed]
Vanderplasschen  W;  Rapp  RC;  Wolf  JR  et al:  The development and implementation of case management for substance use disorders in North America and Europe.  Psychiatric Services 55:913–922, 2004
[CrossRef] | [PubMed]
Hoge  MA;  Davidson  L;  Griffith  EEH  et al:  Defining managed care in public-sector psychiatry.  Hospital and Community Psychiatry 45:1085–1089, 1994
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