title: Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England.
abstract: To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.
  
  
  
  An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission.
  
  
  
  Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types.
  
  
  
  Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.
authors.affiliation: Personal Social Services Research Unit, University of Manchester, UK. mark.wilberforce@manchester.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Wilberforce
authors.affiliation: Personal Social Services Research Unit, University of Manchester, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Tucker
authors.affiliation: Personal Social Services Research Unit, University of Manchester, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Brand
authors.affiliation: Personal Social Services Research Unit, University of Manchester, UK.
authors.forename: Michele
authors.initials: M
authors.lastname: Abendstern
authors.affiliation: Personal Social Services Research Unit, University of Manchester, UK.
authors.forename: Rowan
authors.initials: R
authors.lastname: Jasper
authors.affiliation: Personal Social Services Research Unit, University of Manchester, UK.|Manchester Mental Health and Social Care Trust, Manchester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Challis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000706:statistics & numerical data; D004739:England; D005260:Female; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000628:therapy; D011446:Prospective Studies
keywords: admissions; costs; integrated care; multidisciplinary teams; social work
references.citation: Cochrane Database Syst Rev. 2015 Jan 05;1:CD008345
references.pmid: 25560977
references.citation: Int J Geriatr Psychiatry. 2002 Apr;17(4):315-25
references.pmid: 11994884
references.citation: Health Soc Care Community. 2014 May;22(3):225-33
references.pmid: 23750908
references.citation: Alzheimers Dement. 2012 Sep;8(5):426-36
references.pmid: 22285637
references.citation: Prev Med. 2007 Oct;45(4):247-51
references.pmid: 17950122
references.citation: Int J Geriatr Psychiatry. 1997 Apr;12(4):432-5
references.pmid: 9178046
references.citation: J Interprof Care. 2009 Jul;23(4):341-54
references.pmid: 19370444
references.citation: J Gerontol B Psychol Sci Soc Sci. 2000 Jul;55(4):P247-55
references.pmid: 11584881
references.citation: Health Soc Care Community. 2006 Sep;14(5):408-17
references.pmid: 16918833
references.citation: J Gerontol. 1990 Nov;45(6):S250-8
references.pmid: 2229951
references.citation: Int J Geriatr Psychiatry. 2003 Apr;18(4):298-307
references.pmid: 12673605
references.citation: BMJ. 1991 Apr 13;302(6781):871-5
references.pmid: 1902752
references.citation: Health Soc Care Community. 2003 Mar;11(2):85-94
references.pmid: 14629210
references.citation: Int J Ment Health Nurs. 2012 Jun;21(3):193-201
references.pmid: 22533326
references.citation: Int Psychogeriatr. 2013 Sep;25(9):1485-92
references.pmid: 23731987
references.citation: Gerontologist. 1993 Dec;33(6):714-20
references.pmid: 8314097
references.citation: Int J Geriatr Psychiatry. 2016 Nov;31(11):1208-1216
references.pmid: 26833970
references.citation: BMC Health Serv Res. 2011 May 09;11:93
references.pmid: 21549010
references.citation: Aging Ment Health. 2012;16(7):861-73
references.pmid: 22303810
references.citation: Int J Geriatr Psychiatry. 2011 Mar;26(3):221-8
references.pmid: 20677214
references.citation: Int J Geriatr Psychiatry. 2000 Aug;15(8):687-703
references.pmid: 10960881