Lowering hospital costs is a principal focus of public policy, prompting careful assessment of the cost-effectiveness of medical interventions. This requires the careful evaluation of intervention that can influence the efficiency and quality of health care. Psychiatric consultation is a widely available intervention, but its cost-effectiveness has been minimally studied. This project evaluates efficient, brief screening for psychopathology followed by psychiatric consultation for high-risk patients on general medical inpatient services. Screened patients who receive psychiatric consultation are hypothesized to have better inpatient medical and psychiatric outcome, and better outcomes on post-hospital followup measures of social, occupational, and physical functioning. The direct costs including intervention will be compared to direct and indirect costs without the intervention. During a baseline period of six months, patients admitted to general medical inpatient wards will be screened for psychopathology (cognitive dysfunction, depression, anxiety, and pain), and data will be gathered on short-term medical outcomes, including length of stay and use of diagnostic tests and special medical procedures. The principal cost-effective feature of the intervention is expected to be reduced length of stay. During the experimental period of twelve months, patients will be similarly screened and evaluated in terms of short-term medical outcome. Half of those identified with significant psychopathology by the screening will receive psychiatric consultation. All patients identified by screening will be interviewed for follow-up data at 3 months and 6 months after hospitalization. The follow-up household interview will be used to collect data on disability and work loss days, physical functioning (ADL), perceived health status, hospital readmissions, and post-hospital physician and drug use. Patients who receive psychiatric consultation will be compared to those who screened high but did not receive psychiatric consultation, during both the baseline and experimental periods, in a double comparison research design. This design will test the hypothesis that psychiatric intervention produces favorable inpatient and post-discharge outcomes that measurably reduce the cost of health services. By demonstrating whether a brief, generalizable psychiatric intervention can have positive effects on outcome in medical settings, the project aims to provide findings important to psychiatrists and other physicians, hospital managers and third party payers.
| Levenson, J L; Hamer, R M; Rossiter, L F (1992) A randomized controlled study of psychiatric consultation guided by screening in general medical inpatients. Am J Psychiatry 149:631-7 |
| Levenson, J L; Hamer, R M; Rossiter, L F (1992) Psychopathology and pain in medical in-patients predict resource use during hospitalization but not rehospitalization. J Psychosom Res 36:585-92 |
| Levenson, J L (1991) Experimental study of psychiatric consultation for unrecognized psychopathology in general medical inpatients. Psychiatr Med 9:593-606 |
| Levenson, J L; Hamer, R M; Rossiter, L F (1990) Relation of psychopathology in general medical inpatients to use and cost of services. Am J Psychiatry 147:1498-503 |
