title: A randomized trial of short-term acute residential treatment for veterans.
abstract: OBJECTIVE
  A variety of alternatives to acute psychiatric hospital care have been developed over the past several decades. including San Diego's short-term acute residential treatment (START) program, now comprising a certified and accredited network of six facilities with a total of 75 beds. This study compared outcomes, patient satisfaction, and episode costs for a sample of 99 veterans who received acute care either at an inpatient unit at a Department of Veterans Affairs (VA) hospital or at a START facility.
  
  
  METHODS
  Consenting participants were randomly assigned to one of the two treatment settings. Follow-up was conducted at two months. During the follow-up period, participants received treatment as usual. Multiple standardized measures were used to maximize validity in assessing symptoms, functioning, and quality of life.
  
  
  RESULTS
  Participants who were treated in either a hospital or the START program showed significant improvement between admission, discharge, and two-month follow-up, with few statistically significant differences between the groups in symptoms and functioning. There was some evidence that START participants had greater satisfaction with services. Mean costs for the index episode were significantly lower for START participants (65 percent lower) than for those who were treated in the hospital.
  
  
  CONCLUSIONS
  The results of this study suggest that the START model provides effective voluntary acute psychiatric care in a non-hospital-based setting at considerably lower cost. Efforts to replicate and evaluate the model at additional locations merit attention.
authors.affiliation: Department of Psychiatry, University of California, San Diego, and San Diego County Mental Health Services 92161, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Hawthorne
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Green
authors.forename: Todd
authors.initials: T
authors.lastname: Gilmer
authors.forename: Piedad
authors.initials: P
authors.lastname: Garcia
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hough
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.forename: Linda
authors.initials: L
authors.lastname: Hammond
authors.forename: James B
authors.initials: JB
authors.lastname: Lohr
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002140:California; D006778:Hospitals, Psychiatric; D006801:Humans; D008875:Middle Aged; D008890:Military Psychiatry; D017060:Patient Satisfaction; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*