Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment.
OBJECTIVE
This study compared the outcomes and costs of three models of Department of Veterans Affairs (VA) inpatient treatment for posttraumatic stress disorder (PTSD): 1) long-stay specialized inpatient PTSD units, 2) short-stay specialized evaluation and brief-treatment PTSD units, and 3) nonspecialized general psychiatric units.


METHODS
Data were drawn from 785 Vietnam veterans undergoing treatment at 10 programs across the country. The veterans were followed up at 4-month intervals for 1 year after discharge. Successful data collection averaged 66.1% across the three follow-up intervals.


RESULTS
All models demonstrated improvement at the time of discharge, but during follow-up symptoms and social functioning rebounded toward admission levels, especially among participants who had been treated in long-stay PTSD units. Veterans in the short-stay PTSD units and in the general psychiatric units showed significantly more improvement during follow-up than veterans in the long-stay PTSD units. Greatest satisfaction with their programs was reported by veterans in the short-stay PTSD units. Finally, the long-stay PTSD units proved to be 82.4% and 53.5% more expensive over 1 year than the short-stay PTSD units and general psychiatric units, respectively.


CONCLUSIONS
The paucity of evidence of sustained improvement from costly long-stay specialized inpatient PTSD programs and the indication of high satisfaction and sustained improvement in the far less costly short-stay specialized evaluation and brief-treatment PTSD programs suggest that systematic restructuring of VA inpatient PTSD treatment could result in delivery of effective services to larger numbers of veterans.
Fontana
A
A
VA Northeast Program Evaluation Center, Evaluation Division of the National Center for PTSD, West Haven, CT 06516, USA.
Rosenheck
R
R
D001294:Attitude to Health; D003695:Delivery of Health Care / Q000191:economics; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D011567:Psychiatric Department, Hospital / Q000191:economics; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012931:Social Environment; D013313:Stress Disorders, Post-Traumatic / Q000191:economics / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome