Abstract of Hospitalization Research Undertaken At Threshold Clubhouse, June 2002

Introduction

Threshold sought to replicate a research study done in 1995 that showed a significant positive corollary between utilization of Threshold’s clubhouse model psychiatric rehabilitation program and reduced psychiatric hospitalizations among its members.  Nathania Allen, a Master of Science Administration (MSA) candidate at North Carolina Central University, conducted the research, with assistance from Ali Swiller, Program Director at Threshold, and Laurie Selz-Campbell from the University of North Carolina School of Social Work.

Methodology

Data from two separate groups of adults with serious mental illness was generated and then compared.  The data consisted of the following categories: age, gender, ethnicity, diagnosis and level of functioning.  Each group consisted of 25 persons who met all qualifications to participate in Threshold’s program.  The two groups were known to differ in one area.  The individuals in one group (Group A) had been referred to Threshold’s mental health rehabilitation program, attended orientation, and become members after completing the admission process.  The other group (Group B) had been referred, attended orientation, but never completed the admission process to become a member.  Medical records for each group were reviewed as a means to conduct a comparative analysis of their hospitalizations. All 50 persons were referred to Threshold over a five-year span beginning January 1, 1996, through December 31, 2001.

The demographic, diagnostic and level of functioning data was essentially the same for both groups.   Both groups were made up of adults with essentially the same range of ages, gender and ethnicity. Both groups were made up of adults with essentially the same range of serious mental disorders such as schizophrenia, schizoaffective disorder, major depressive disorder and bipolar disorder.  Both groups received essentially equivalent North Carolina Functional Assessment Scales, a level of functioning used to develop a Pioneer Level of Eligibility (LOE).  A Pioneer LOE of 1 (severe) or 2 (moderate) is required for an admission to a psychosocial rehabilitation program for the units of service generated to earn state dollars.  All the persons in both groups had an LOE of 1 or 2.

In examining the number of hospitalizations and duration of hospitalizations for Group A, the following data was generated:

	Before Referral to Threshold	After Referral to Threshold
Total Number of Hospitalizations:	37	12
Total Number of Days:	7038	176
Average Number of Days:	190.2	14.7

In examining the number of hospitalizations and duration of hospitalizations for Group B, the following data was generated:

	Before Referral to Threshold	After Referral to Threshold
Total Number of Hospitalizations:	38	18
Total Number of Days:	2142	789
Average Number of Days:	56.4	43.8

Analysis

For Group A, persons who were referred and became members of Threshold, the number of hospitalizations was 67.6% less as compared to the number of hospitalizations before joining Threshold.  The total number of days was 97.5% less when comparing the number after referral to those prior to referral.  The average number of days of hospitalization was 92% less when comparing the three-year period after referral to the three-year period prior to referral.

For Group B, persons referred to Threshold but refusing services, the number of hospitalizations was 53% less as compared to the number of hospitalizations before referral.  The total number of days of hospitalization was 63% less when compared to the number after referral to those prior to referral.  The average number of days of hospitalization was 23% less when compared to the number of days prior to referral.

Comparing the two groups yields the following:  Group B was hospitalized a total of 6 more times than Group A.  Group B was hospitalized for 613 more days than Group A when comparing data after referral  and/or admission to Threshold.  Group B was hospitalized an average of 29 more days per hospitalization than Group A when comparing data after referral and/or admission to Threshold.

A number of factors may have affected the number and duration of hospitalizations, including a move towards shorter hospitalizations on the part of Area Programs and/or State Hospitals, improved programs to prevent hospitalization, and the availability of better, more effective medications.  The statistics show that although the number of hospitalizations prior to referral to Threshold was almost exactly the same, Group A had been hospitalized for significantly longer periods of time than Group B.  These statistics would indicate that Group A had episodes of more severe decompensation than Group B.  However, the reduction in the number and the considerable reduction in duration of hospitalizations after persons were referred and joined Threshold is significant in that the only variable of difference is the participation in Threshold’s mental health rehabilitation services.  Thus, the Threshold program of mental health rehabilitation reduced hospitalizations and length of hospitalizations among its members significantly.

The cost to hospitalize one adult for one day at John Umstead, the closest of North Carolina’s state psychiatric hospitals, is $336.  Group A had a total cost of $59,136 in hospitalizations (176 days at $336 per day) in the three-year period after referral and admission to Threshold.  Group B had a total cost of $265,104 in hospitalizations (789 days at $336 per day) in the three-year period after referral to and declining membership at Threshold.  A savings of $205, 968 in hospitalization costs was achieved by reducing the number and duration of hospitalizations among those 25 persons who were referred to Threshold and took advantage of its services.

Implications

The primary implication of this research is that there is a positive relationship between utilization of the clubhouse model program of psychiatric rehabilitation at Threshold and reduced utilization of inpatient services.  By reducing hospitalizations by one-third among the 25 members in the sample, a savings of $205,968 was achieved.

Threshold calculated its cost to serve one member for one day at $28.72 for FY 2000-2001.  With the cost to hospitalize someone at John Umstead at $336 for one day, genuine savings can be realized by serving persons in the clubhouse model program of rehabilitation at Threshold and elsewhere in the state of North Carolina.  11 persons may be served at Threshold for a day for what it costs to hospitalize 1 person at John Umstead.  With the proven diversionary quality of the clubhouse model, a strong case can be made to increase the support of this way of working.