Intensive Case Management and Rehospitalization: A Survival Analysis

This study evaluated the efficacy of an intensive-case management program in extending community tenure and reducing rates of rehospitalization for mentally ill outpatients. The study group was composed of 196 individuals with a history of state psychiatric hospitalization. One subgroup of subjects was composed of all clients currently receiving intensive case management (ICM) services (n = 108). A second subgroup, the control group, was made up of randomly selected clients (n = 88) eligible for intensive case management services. Survival analysis models were tested to derive a model that contained the maximum number of significant covariates predictive of community tenure (survival) until rehospitalization. After statistically controlling for these covanates, clients in the control group were 41.2 % less likely to be rehospitalized (survival). Clients most at risk of rehospitalization were ICM clients who received shorter intervals of intensive case management; higher levels of services per month; and had experienced brief, frequent prior hospitalizations. Since the late 1970s, case management services for the severely and persis-tently mentally ill have increasingly been used to assist deinstitutionalized inpatients in remaining in the community (Curtis, Millman, Struening, & D’Ercole, 1992). Case management is generally defined as a means for the coordination and distribution of services (Thornicroft, 1991). Brennan and Kaplan (1993) state, &dquo;The primary of goal of case management is to optimize client functioning by providing high-quality services in the most efficient and effective manner to individuals with multiple complex needs&dquo; (p. 220)