Impact of the San Diego Serial Inebriate Program on use of emergency medical resources.
OBJECTIVE
We determine the impact of a treatment strategy called the San Diego Serial Inebriate Program on the use of emergency medical services (EMS) and emergency department (ED) and inpatient services by individuals repeatedly arrested for public intoxication.


METHODS
This was a retrospective review of health care utilization records (EMS, ED, and inpatient) of 529 individuals from 2000 to 2003. Judges offered individuals a 6-month outpatient treatment program in lieu of custody (Serial Inebriate Program). Demographics and health care utilization are reported overall and by treatment acceptance.


RESULTS
From 2000 to 2003, 308 of 529 (58%) individuals were transported by EMS 2,335 times; 409 of 529 (77%) individuals amassed 3,318 ED visits, and 217 of 529 (41%) individuals required 652 admissions, resulting in 3,361 inpatient days. Health care charges totaled $17.7 million (EMS, $1.3 million; ED, $2.5 million; and inpatient, $13.9 million). Treatment was offered to 268 individuals, and 156 (58%) accepted. Use of EMS, ED, and inpatient services declined by 50% for clients who chose treatment, resulting in an estimated decrease in total monthly average charges of $5,662 (EMS), $12,006 (ED), and $55,684 (inpatient). There was no change in use of services for individuals who refused treatment. There was a significant increasing trend in acceptance among individuals with longer jail sentences (<0.001). Treatment acceptance was 20% among those with sentences of 0 to 30 days and reached 63% for those with sentences longer than 150 days. Operational costs and alternate care at clinics and nonparticipating hospitals were not analyzed.


CONCLUSIONS
This community-supported treatment strategy reduced the use of EMS, ED, and inpatient resources by individuals repeatedly intoxicated in public.
Dunford
James V
JV
Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, CA 92103, USA. jdunford@ucsd.edu
Castillo
Edward M
EM
Chan
Theodore C
TC
Vilke
Gary M
GM
Jenson
Peter
P
Lindsay
Suzanne P
SP
D000328:Adult; D000437:Alcoholism / Q000191:economics* / Q000534:rehabilitation*; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D002140:California; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006703:Ill-Housed Persons; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010343:Patient Admission; D011329:Prisoners; D012189:Retrospective Studies; D013997:Time Factors