February 2001

From Yale University

Cutting inpatient psychiatric care does not reduce overall success rate for posttraumatic stress disorder patients, Yale researcher shows

When VA hospitals cut inpatient psychiatric care, there is no overall reduction in effective care and clinical outcomes for posttraumatic stress disorder (PTSD) patients, Yale researchers report in the February issue of 15 Medical Care.

"We found no loss of overall effectiveness at programs that shortened their average length of stay," said Robert Rosenheck, professor of psychiatry and in the Department of Epidemiology and Public Health at Yale. "But the programs that shifted from a hospital-based program to a low-cost residential rehabilitation program, did show some decreased effectiveness. This problem might not lie with the residential model, but with the shift from the hospital setting. The staff might have had to make adjustments in service delivery."

Rosenheck looked at the consequences of reducing beds by evaluating detailed clinical outcomes on 6,397 veterans treated between 1993 and 2000 at 35 specialized VA inpatient and residential programs for PTSD. As controls, Rosenheck also included a set of in-patient and rehabilitation programs that didn't change at all.

"The reduction in length of stay seems to have had no adverse effect on program effectiveness," said Rosenheck, who is also director of the VA's Northeast Program Evaluation Center. "In contrast, programs that shifted from an inpatient to a residential model were less effective, especially in the areas of substance abuse and violent behavior."

The most consistent change affecting the American health care system in the last decade, Rosenheck said, is the reduction in the availability of inpatient hospital care. "This is especially true in the area of mental health, where there have been reductions of between 30 and 60 percent in in-patient services," he said.

Like the rest of American health care, the Department of Veterans Affairs has undergone tumultuous change, Rosenheck said, especially in the move away from hospital-based care. Rosenheck has been studying the impact of this on mental health patients for the past five years. His past research has examined the specific effects of these changes in veterans treated for posttraumatic stress disorder, most of whom served in the Vietnam War.

Rosenheck's collaborator on the study was Alan Fontana, research scientist in psychiatry at Yale and in the Northeast Program Evaluation Center at the VA Connecticut Healthcare System.

Rosenheck can be reached at 203-937-3850 or by e-mail at robert.rosenheck@yale.edu.












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