Effectiveness of a High End Users Program for Persons with Psychiatric Disorders

Objective: To evaluate the effectiveness of an intensive system of case management, High End User (HEU) program, in reducing psychiatric inpatient utilization at least 50%. Methods: Pre- post analysis compared 2004-07 utilization between intervention and comparison groups. Both groups met the criteria of HEU by virtue of multiple episodes or long stay (30 days or more) in a 12 month period. Propensity sore was used to correct for selection bias. Data from Medicaid claims and consumer reporting forms were used. Logistic regression was used to predict the probability of an inpatient episode in the post period. Results: Majority of HEU, regardless of participation in intervention program, had a reduction of 50% or more in inpatient days. Logistic regression results indicate that being in an HEU intervention program did not result in greater inpatient reduction, after adjusting for covariates. Conclusion: Our results are consistent with previous studies that find that majority of HEU have lower utilization in the following year, regardless of an intervention. Our study indicates that most HEU have one major crisis episode that is not repeated in the following year.