Efficacy of Transitional Case Management Following Psychiatric Hospital Discharge
Condition: Mental Disorders
MeSH terms: Mental Disorders
Study type: Interventional

Summary: 
      Efficacy of transitional case management following psychiatric hospital discharge: a
      randomized trial

      Background The movement of deinstitutionalisation in Western societies has modified the role
      of psychiatric hospital, which has lost its asylum function to become a place for acute care.

      Psychiatric stays are now shorter and close interactions with the outpatient care network is
      therefore more critical than before. The first weeks following discharge from psychiatric
      hospital represent a period of high risk for relapse, readmission or even suicide. Case
      management has a proven efficacy in facilitating patients' deinstitutionalisation after very
      long hospitalisations and in stabilizing high users of psychiatric care. In contrast, studies
      exploring the impact of time limited case management following discharge from short stays
      (transitional case management) in earlier phases of psychiatric disorders in connection with
      primary care are lacking.

      Working Hypotheses The investigators hypothesize that transitional case management following
      hospital discharge decreases risk of readmission, improves adherence to outpatient care,
      facilitates recovery and improves patients' satisfaction with treatment as compared to
      routine care.

      Specific Aims In this study, the investigators will compare the impact of both intervention
      on number of contact and level of adherence to outpatient care. The investigators will also
      compare both groups on number of readmission, risk of early aggravation of the disorders,
      level of functioning and satisfaction with care.

      Methods This is a randomized single-blind study comparing transitional case management after
      discharge with routine post-hospitalization care for subjects living independently without
      institutional psychiatric follow-up. Demographic and clinical data will be gathered during
      hospitalization, and 1, 3, 6 and 12 months after discharge. Quantitative assessment of
      outcomes using validated instruments will be: contact and level of adherence to outpatient
      care (primary outcomes), as well as number of hospitalization days, number of readmissions,
      severity of illness and satisfaction with care (secondary outcomes).

      Expected Value of the Proposed Project This study should improve psychiatric patients
      follow-up in collaboration with the different levels of care in the global context of
      deinstitutionalization.
    


Intervention name(s): Transitional Case Management; Standard Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The case management activity deals with organizational and clinical aspects. The objective is to focus on network's expectations during hospitalization and at discharge, and ensure contacts between hospital and patient' social network. The aim is to support patient during the transition phase following discharge; Routine hospitalization care is broadly defined as the usual level of care in the context of the adult department of psychiatry of the CHUV (Centre Hospitalier Universitaire Vaudois).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Case management; psychiatric hospitalization; discharge