title: Service use and costs of supporting the most socially disabled patients in a hospital reprovision programme. A two-hospital comparison.
abstract: BACKGROUND
  The UK, in common with other Western countries, has seen a marked reduction in the number of long-stay hospital beds over the past few decades and most asylums have been closed. Whilst hospital closure and discharge programmes differ, a common characteristic is likely to be that those patients who are "difficult-to-place" in the community are amongst the last to be discharged. This paper compares service use and costs of difficult-to-place patients from two UK hospitals (Friern and Warley) and identifies predictors of cost. One of these hospitals (Warley) provided a more intensive programme of rehabilitation.
  
  
  METHODS
  The study included 84 patients (Friern 63, Warley 21). Patient characteristics prior to discharge were recorded. Service use was measured and costs calculated for the year following discharge. Comparisons were made between the Warley and Friern groups and cost predictors were identified using multiple regression analysis.
  
  
  RESULTS
  Post-discharge accommodation, in-patient and outpatient costs were substantially higher for the Friern group, whilst the Warley group had higher day care costs. The total mean costs were pound 13,432 higher for the Friern group. However, non-accommodation costs were substantially higher for the Warley group. Patients with more social skills had higher non-accommodation costs. Higher total costs were associated with more self-care skills, fewer domestic skills and younger age. Longer length of stay prior to discharge was associated with higher non-accommodation and total costs.
  
  
  CONCLUSIONS
  The costs of care following discharge differed substantially between these two groups. This is partly a supply effect given the different strategies for caring for these difficult-to-place patients. In common with other studies, patient characteristics can explain some of the differences in future costs.
authors.affiliation: P024 Centre for the Economics of Mental Health, Health Services Research Dept., Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK. p.mccrone@iop.kcl.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Angela
authors.initials: A
authors.lastname: Hallam
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Francis
authors.initials: F
authors.lastname: Swaray
authors.forename: Ana
authors.initials: A
authors.lastname: Nazir
authors.forename: Julian
authors.initials: J
authors.lastname: Leff
authors.forename: Andrew
authors.initials: A
authors.lastname: Szmidla
mesh_terms: D003688:Deinstitutionalization / Q000191:economics*; D006233:Persons with Disabilities; D005260:Female; D017048:Health Care Costs; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D016730:Program Development; D012944:Social Support; D006113:United Kingdom / Q000453:epidemiology