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Am J Psychiatry 1996; 153:1065-1073
Copyright © 1996 by American Psychiatric Association
Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes
WH Sledge, J Tebes, J Rakfeldt, L Davidson, L Lyons and B Druss
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
OBJECTIVE: The authors investigated the clinical feasibility and the
outcome for patients of a program designed as an alternative to acute
hospitalization. METHOD: This was a random-design study comparing a
conventional inpatient program for urban, poor, severely ill voluntary
patients who usually require hospitalization to an alternative experimental
program consisting of a day hospital linked to a crisis residence. Patients
were assessed with standardized measures of symptoms, functioning, social
adjustment, quality of life, and satisfaction with clinical services upon
admission to the study, at discharge from the index admission, and at
follow-ups 2, 5, and 10 months after discharge. RESULTS: One hundred
ninety-seven patients were enrolled in the 2-year research program and
followed for 10 months. Of the voluntary patients who would have been
admitted to the hospital, 83% were appropriate for the experimental
program. The clinical, functional, social adjustment, quality of life, and
satisfaction outcome measures were not statistically different for the
patients in the two treatment conditions; however, there was a slightly
more positive effect of the experimental program on measures of symptoms,
overall functioning, and social functioning. CONCLUSIONS: The experimental
condition, a combined day hospital/crisis respite community residence,
seems to have had the same treatment effectiveness as acute hospital care
for urban, poor, acutely ill voluntary patients with severe mental illness.
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