UPBEAT: the impact of a psychogeriatric intervention in VA medical centers. Unified Psychogeriatric Biopsychosocial Evaluation and Treatment.
BACKGROUND
The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services.


OBJECTIVE
To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use.


METHODS
Randomized trial.


METHODS
Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873).


METHODS
The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates.


RESULTS
Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069).


CONCLUSIONS
UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.
Kominski
G
G
UCLA School of Public Health, Los Angeles, CA, USA. kominski@ucla.edu
Andersen
R
R
Bastani
R
R
Gould
R
R
Hackman
C
C
Huang
D
D
Jarvik
L
L
Maxwell
A
A
Moye
J
J
Olsen
E
E
Rohrbaugh
R
R
Rosansky
J
J
Taylor
S
S
Van Stone
W
W
D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D005852:Geriatric Psychiatry / Q000458:organization & administration*; D006304:Health Status; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000706:statistics & numerical data*; D014728:Veterans