Alternatives to standard acute in-patient care in England: short-term clinical outcomes and cost-effectiveness.
BACKGROUND
Outcomes following admission to residential alternatives to standard in-patient mental health services are underresearched.


OBJECTIVE
To explore short-term outcomes and costs of admission to alternative and standard services.


METHODS
Health of the Nation Outcome Scales (HoNOS), Threshold Assessment Grid (TAG), Global Assessment of Functioning (GAF) and admission cost data were collected for six alternative services and six standard services.


RESULTS
All outcomes improved during admission for both types of service (n = 433). Adjusted improvement was greater for standard services in scores on HoNOS (difference 1.99, 95% CI 1.12-2.86), TAG (difference 1.40, 95% CI 0.39-2.51) and GAF functioning (difference 4.15, 95% CI 1.08-7.22) but not GAF symptoms. Admissions to alternatives were 20.6 days shorter, and hence cheaper (UK pound3832 v. pound9850). Standard services cost an additional pound2939 per unit HoNOS improvement.


CONCLUSIONS
The absence of clear-cut advantage for either type of service highlights the importance of the subjective experience and longer-term costs.
Slade
M
M
Health Service and Population Research Department, Box PO29, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. m.slade@iop.kcl.ac.uk.
Byford
S
S
Barrett
B
B
Lloyd-Evans
B
B
Gilburt
H
H
Osborn
D P J
DP
Skinner
R
R
Leese
M
M
Thornicroft
G
G
Johnson
S
S
D000208:Acute Disease; D000328:Adult; D016000:Cluster Analysis; D015331:Cohort Studies; D003155:Community Mental Health Centers / Q000191:economics*; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012044:Regression Analysis; D013997:Time Factors