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Am J Psychiatry 1997; 154:758-765
Copyright © 1997 by American Psychiatric Association
Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment
A Fontana and R Rosenheck
VA Northeast Program Evaluation Center, Evaluation Division of the National Center for PTSD, West Haven, CT 06516, USA.
OBJECTIVE: This study compared the outcomes and costs of three models of
Department of Veterans Affairs (VA) inpatient treatment for posttraumatic
stress disorder (PTSD): 1) long-stay specialized inpatient PTSD units, 2)
short-stay specialized evaluation and brief- treatment PTSD units, and 3)
nonspecialized general psychiatric units. METHOD: Data were drawn from 785
Vietnam veterans undergoing treatment at 10 programs across the country.
The veterans were followed up at 4- month intervals for 1 year after
discharge. Successful data collection averaged 66.1% across the three
follow-up intervals. RESULTS: All models demonstrated improvement at the
time of discharge, but during follow-up symptoms and social functioning
rebounded toward admission levels, especially among participants who had
been treated in long-stay PTSD units. Veterans in the short-stay PTSD units
and in the general psychiatric units showed significantly more improvement
during follow- up than veterans in the long-stay PTSD units. Greatest
satisfaction with their programs was reported by veterans in the short-stay
PTSD units. Finally, the long-stay PTSD units proved to be 82.4% and 53.5%
more expensive over 1 year than the short-stay PTSD units and general
psychiatric units, respectively. CONCLUSIONS: The paucity of evidence of
sustained improvement from costly long-stay specialized inpatient PTSD
programs and the indication of high satisfaction and sustained improvement
in the far less costly short-stay specialized evaluation and
brief-treatment PTSD programs suggest that systematic restructuring of VA
inpatient PTSD treatment could result in delivery of effective services to
larger numbers of veterans.
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