title: [Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study].
abstract: BACKGROUND
  People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain).
  
  
  METHODS
  We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals.
  
  
  RESULTS
  In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78% belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study.
  
  
  CONCLUSIONS
  It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness.
authors.affiliation: Servicio de Psiquiatría, Centro de Salud Mental Antonio Machado, Complejo Asistencial de Segovia, Segovia, España. juanmasendra@hotmail.com
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sendra-Gutiérrez
authors.forename: Rosario
authors.initials: R
authors.lastname: Álvarez
authors.forename: Ana
authors.initials: A
authors.lastname: Tejedor
authors.forename: Ana M
authors.initials: AM
authors.lastname: Arroyo
authors.forename: Isabel
authors.initials: I
authors.lastname: Criado
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Asensio
authors.forename: Martín L
authors.initials: ML
authors.lastname: Vargas
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult