Impact of a specialized early intervention service for psychotic disorders on patient characteristics, service use, and hospital costs in a defined catchment area.
OBJECTIVE
To evaluate the impact of a new early intervention service for first-episode psychosis on patient characteristics, service use, and hospital costs.


METHODS
We examined clinical records of all first admissions to hospitals of patients diagnosed with first-episode psychoses (nonaffective) over a 3-year period before and after the introduction of an early intervention service, the Prevention and Early Intervention Program for Psychosis (PEPP), in a defined catchment area. We examined demographic, clinical, and service use indices covering a 2-year period subsequent to the index admission for each patient.


RESULTS
Patients in the post-PEPP phase were significantly younger (P < 0.01), were more often male (P < 0.05), and were less likely to be admitted to hospital with an involuntary status (P < 0.05) or with injuries (P < 0.05) at the time of their first hospital admission. Over the 2 years following the initial admission, post-PEPP patients had significantly fewer admissions to a regular psychiatric service (P < 0.001) and made significantly fewer visits to the hospital emergency department (P < 0.01). There was a significant mean reduction in costs per case of regular hospital bed use ($1028.49, SD 528.02, compared with $792.28, SD 528.02; P < 0.01) and emergency visits ($519.18, SD 353.79, compared with $353.79, SD 345.0; P < 0.01). Time series analyses followed by Chow tests failed to confirm that these cost changes could be attributed specifically to the introduction of an early intervention service.


CONCLUSIONS
Introduction of a specialized early intervention program may be beneficial to patients and to the health care system. To evaluate the cost-benefit ratio of early intervention services, longer term and more detailed data may be required.
Goldberg
Karen
K
Prevention and Early Intervention Program for Psychoses-Montreal, Douglas Hospital Research Centre, Quebec.
Norman
Ross
R
Hoch
Jeffrey S
JS
Hoch
Jeff
J
Schmitz
Norbert
N
Windell
Deborah
D
Brown
Nicole
N
Malla
Ashok
A
D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000191:economics* / Q000534:rehabilitation*