A comparison between enhanced and traditional case management aftercare follow-up for substance dependence and hospital readmission in a managed care organization
An after-only nonequivalent quasi-experimental research design was used to compare differences between enhanced and traditional case management aftercare followup for hospital readmission of patients diagnosed with substance dependence. It has become increasingly important to track and measure continuity of patient care and follow up as patients, employers, third party reimbursement agencies, and legal mandates demand feedback on effectiveness of outcomes. These mandates cover all aspects of patient care: case management, cost, and readmission, yet their relationships to a managed behavioral health care organization are unknown. Donabedian' s conceptual :framework of the structure-process-outcome paradigm was used to guide this study. The four research questions offered an overview of the different types of case management provided, the type of coverage, and the outcomes of both readmissions and costs. The total population of 250,000 commercial and Medicare enrollees in a southern branch of a behavioral health managed care was sampled. The sample.consisted of208 individuals with a primary inpatient admission diagnosis of substance dependence, and was subdivided into two groups; patients who received traditional case management follow-up (n. = 61), and those who received enhanced follow-up (n. = 14 7). Descriptive and inferential statistics were used to analyze the data. No significant relationship was found between type of case management and likelihood of readmission. Significant difference (n < .001) was noted in the likelihood of readmission between substance dependent patients enrolled in the two coverage groups. The costs associated with enhanced case management follow-up were significantly higher (n < .001) than those of traditional follow-up. In terms of years of prior treatment, a significant difference (n = .001) was found between patients readmitted to the hospital with a diagnosis of substance dependence and those who were not readmitted. Recommendations for future research included the design of an experimental study of patients 65 years or older with a primary or secondary diagnosis of substance dependence, and/or concomitant mental health diagnoses and at least one episode of prior treatment in order to identify specific readmission risk factors for case management focus, as well as to compare outcomes related to readmission and costs between groups.