Continuity of care and health care costs among persons with severe mental illness.
OBJECTIVE
Although the association between continuity of care and health outcomes among persons with severe mental illness is beginning to be elucidated, the association between continuity and costs has remained virtually unexplored. The purpose of this study was to examine the relationship of continuity of care and health care costs in a sample of 437 adults with severe mental illness in three health regions of Alberta, Canada.


METHODS
Service use events and costs were tracked through self-reported and administrative data. Associations between continuity and costs were examined by using analysis of variance and regression analysis.


RESULTS
Mean+/-SD total, hospital, and community cost over the 17-month study period were $24,070+/-$25,643, $12,505+/-$20,991, and $2,848+/-$4,420, respectively. The difference in means across levels of observer-rated continuity was not statistically significant for total cost, but improved continuity was associated with both lower hospital cost and higher community cost. Total cost was significantly lower for patients with a higher self-rated quality of life as indicated on the EQ-5D visual analogue scale, although associations did not hold up in the regression analysis. Patients with higher functioning as rated by the Multnomah Community Abilities Scale had significantly lower total and community costs.


CONCLUSIONS
The study showed a relationship between continuity of care and both hospital and community costs. The data also indicate that a relationship exists between cost and level of patient functioning. It will be necessary to conduct further studies using experimental designs to examine the impact of shifting resources from hospitals to the community, particularly for high-need patients, on continuity of care and subsequent outcomes.
Mitton
Craig R
CR
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada. cmitton@exchange.ubc.ca
Adair
Carol E
CE
McDougall
Gerry M
GM
Marcoux
Gisele
G
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000328:Adult; D000416:Alberta; D000704:Analysis of Variance; D003156:Community Mental Health Services / Q000191:economics; D003266:Continuity of Patient Care / Q000191:economics*; D003361:Cost Allocation; D003362:Cost-Benefit Analysis; D004467:Economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000191:economics* / Q000534:rehabilitation; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis