Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T11:25:08.176Z Has data issue: false hasContentIssue false
  • English
  • Français

A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care

Published online by Cambridge University Press:  11 April 2011

Laura Grigoletti ,
Francesco Amaddeo ,
Aldrigo Grassi ,
Massimo Boldrini ,
Marco Chiappelli ,
Mauro Percudani ,
Francesco Catapano ,
Andrea Fiorillo ,
Francesco Perris  and
Maurizio Bacigalupi
...Show all authors
Laura Grigoletti*
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona (Italy)
Francesco Amaddeo
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona (Italy)
Aldrigo Grassi
Affiliation:
“Scalo” Mental Health Centre, Bologna (Italy)
Massimo Boldrini
Affiliation:
“Scalo” Mental Health Centre, Bologna (Italy)
Marco Chiappelli
Affiliation:
“Scalo” Mental Health Centre, Bologna (Italy)
Mauro Percudani
Affiliation:
Mental Health Department, Hospital of Legnano (Milan); present address: Mental Health Department, “G. Salvini” Hospital, Garbagnate Milanese (Italy)
Francesco Catapano
Affiliation:
Psychiatry Department, Second University of Naples, Naples (Italy)
Andrea Fiorillo
Affiliation:
Psychiatry Department, Second University of Naples, Naples (Italy)
Francesco Perris
Affiliation:
Psychiatry Department, Second University of Naples, Naples (Italy)
Maurizio Bacigalupi
Affiliation:
Mental Health Department ASL Rome B, Rome (Italy)
Paolo Albanese
Affiliation:
Mental Health Department ASL Rome B, Rome (Italy)
Simona Simonetti
Affiliation:
Mental Health Department ASL Rome B, Rome (Italy)
Paola De Agostini
Affiliation:
Economic Sciences Department, University of Verona, Verona (Italy)
Michele Tansella
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona (Italy)
*
Address for correspondence: Dr. L. Grigoletti, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, Ospedale Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy). Fax: +39-045-8124889 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Aim – To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages. Methods – Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs. Results – Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users. Conclusion – It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

Keywords

mental health servicesfinancial managementeconomic modelsdecision support techniques
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 19 , Issue 2 , June 2010 , pp. 168 - 177
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albizu-Garcia, C. E., Alegria, M., Freeman, D. & Vera, M. (2001). Gender and health services use for a mental health problem. Social Science and Medicine 53, 865–878.CrossRefGoogle ScholarPubMed
Amaddeo, F., Zambello, F., Tansella, M. & Thornicroft, G. (2001). Accessibility and pathways to psychiatric care in a communitybased mental health system. Social Psychiatry and Psychiatric Epidemiology 36, 500–507.CrossRefGoogle Scholar
Bhui, K., Stansfeld, S., Hull, S., Priebe, S., Mole, F. & Feder, G. (2003). Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. British Journal of Psychiatry 182, 105–116.CrossRefGoogle ScholarPubMed
Carr, V.J., Johnston, P.J., Lewin, T.J., Rajkumar, S., Carter, G.L. & Issakidis, C. (2003). Patterns of service use among persons with schizophrenia and other psychotic disorders. Psychiatric Services 54, 226–235.CrossRefGoogle ScholarPubMed
Commander, M.J., O'Dell, S.M., Surtees, P.G. & Sashidharan, S.P. (2003). Characteristics of patients and patterns of psychiatric service use in ethnic minorities. International Journal of Social Psychiatry 49, 216–224.CrossRefGoogle ScholarPubMed
De Agostini, P., Bonizzato, P., Amaddeo, F., Bisoffi, G., Perali, F. & Tansella, M. (2001). For a more rational funding system of mental health services. Analyses of costs for services supplied by community mental health services during a 7-year period. Epidemiologia e Psichiatria Sociale. 10(3),163–79.CrossRefGoogle Scholar
Efron, B. & Tibshirani, R. (1993). An Introduction to the Bootstarp, Chapman and Hall: Washington.CrossRefGoogle Scholar
Fattore, G., Percudani, M., Pugnoli, C. & Contini, A. (1997). Costs of psychiatric services: a study performed at a public mental center in the Lombardy Region, Italy. Epidemiologia e Psichiatria Sociale 6, 139–147.CrossRefGoogle Scholar
Friedman, J.H. & Meulman, J.J. (2003). Multiple additive regression trees with application in epidemiology. Statistics in Medicine 22, 1365–1381.CrossRefGoogle ScholarPubMed
Goodwin, R.D., Hoven, C.W., Lyons, J.S. & Stein, M.B. (2002). Mental health service utilization in the United States. The role of personality factors. Social Psychiatry and Psychiatric Epidemiology 37, 561–566.CrossRefGoogle ScholarPubMed
Grigoletti, L., Amaddeo, F., Grassi, A., Boldrini, M., Chiappelli, M., Percudani, M., Catapano, F., Fiorillo, A., Bartoli, L., Bacigalupi, M., Albanese, P., Simonetti, S., Perali, F., De, A.P. & Tansella, M. (2006). Proposal for a new funding system for mental health departments. Results from an evaluative multicentre Italian study (I-psycost). Epidemiologia e Psichiatria Sociale 15, 295–306.CrossRefGoogle ScholarPubMed
Keown, P., Holloway, F. & Kuipers, E. (2005). The impact of severe mental illness, co-morbid personality disorders and demographic factors on psychiatric bed use. Social Psychiatry and Psychiatric Epidemiology 40, 42–49.CrossRefGoogle ScholarPubMed
Lindamer, L.A., Bailey, A., Hawthorne, W., Folsom, D.P., Gilmer, T.P., Garcia, P., Hough, R.L. & Jeste, D.V. (2003). Gender differences in characteristics and service use of public mental health patients with schizophrenia. Psychiatric Services 54, 1407–1409.CrossRefGoogle ScholarPubMed
Lora, A., Bezzi, R., Di Vietri, R., Gandini, A., Spinogatti, F. & Zocchetti, C. (2002). Packages of care in the departments of mental health in Lombardy. Epidemiologia e Psichiatria Sociale 11, 100–115.CrossRefGoogle ScholarPubMed
Lora, A., Cosentino, U., Gandini, A. & Zocchetti, C. (2007). Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy). Epidemiologia e Psichiatria Sociale 16, 330–338.CrossRefGoogle ScholarPubMed
Mojtabai, R., Herman, D., Susser, E.S., Sohler, N., Craig, T.J., Lavelle, J. & Bromet, E.J. (2005). Service use and outcomes of first-admission patients with psychotic disorders in the Suffolk County Mental Health Project. American Journal of Psychiatry 162, 1291–1298.CrossRefGoogle ScholarPubMed
Moos, R.H., McCoy, L. & Moos, B.S. (2000). Global assessment of functioning (GAF) ratings: determinants and role as predictors of one-year treatment outcomes. Journal of Clinical Psychology 56, 449–461.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., Hosman, C., McGuire, H., Rojas, G. & van Ommeren, M. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 370, 991–1005.CrossRefGoogle ScholarPubMed
Percudani, M., Gerzeli, S., Massagrandi, R., Jommi, C., Fattore, G., Cerati, G. & Contini, A. (2003). Costs and outcome of care in subjects with severe mental disorders. Epidemiologia e Psichiatria Sociale 12, 175–186.CrossRefGoogle ScholarPubMed
Rossi, A., Sandri, M., Bianco, M., Marsilio, A., Tansella, M. & Amaddeo, F. (2006). Factors associated with clinicians’ dispositions in an outpatient psychiatric department. Social Psychiatry and Psychiatric Epidemiology 41, 832–840.CrossRefGoogle Scholar
Slade, M., Amering, M. & Oades, L. (2008). Recovery: an international perspective. Epidemiologia e Psichiatria Sociale 17, 128–137.CrossRefGoogle ScholarPubMed
STATA Corporation (2003). STATA Statistical Software. Release 8.0. Texas.Google Scholar
Tait, L., Birchwood, M. & Trower, P. (2003). Predicting engagement with services for psychosis: insight, symptoms and recovery style. British Journal of Psychiatry 182, 123–128.CrossRefGoogle ScholarPubMed
Tansella, M. (2007). Does socio-economic status influence the use of mental health services? Epidemiologia e Psichiatria Sociale 16, 1–2.CrossRefGoogle ScholarPubMed