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A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care

Published online by Cambridge University Press:  11 April 2011

Laura Grigoletti ,
Francesco Amaddeo ,
Aldrigo Grassi ,
Massimo Boldrini ,
Marco Chiappelli ,
Mauro Percudani ,
Francesco Catapano ,
Andrea Fiorillo ,
Francesco Perris  and
Maurizio Bacigalupi
...Show all authors
Laura Grigoletti*
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona (Italy)
Francesco Amaddeo
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona (Italy)
Aldrigo Grassi
Affiliation:
“Scalo” Mental Health Centre, Bologna (Italy)
Massimo Boldrini
Affiliation:
“Scalo” Mental Health Centre, Bologna (Italy)
Marco Chiappelli
Affiliation:
“Scalo” Mental Health Centre, Bologna (Italy)
Mauro Percudani
Affiliation:
Mental Health Department, Hospital of Legnano (Milan); present address: Mental Health Department, “G. Salvini” Hospital, Garbagnate Milanese (Italy)
Francesco Catapano
Affiliation:
Psychiatry Department, Second University of Naples, Naples (Italy)
Andrea Fiorillo
Affiliation:
Psychiatry Department, Second University of Naples, Naples (Italy)
Francesco Perris
Affiliation:
Psychiatry Department, Second University of Naples, Naples (Italy)
Maurizio Bacigalupi
Affiliation:
Mental Health Department ASL Rome B, Rome (Italy)
Paolo Albanese
Affiliation:
Mental Health Department ASL Rome B, Rome (Italy)
Simona Simonetti
Affiliation:
Mental Health Department ASL Rome B, Rome (Italy)
Paola De Agostini
Affiliation:
Economic Sciences Department, University of Verona, Verona (Italy)
Michele Tansella
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona (Italy)
*
Address for correspondence: Dr. L. Grigoletti, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, Ospedale Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy). Fax: +39-045-8124889 E-mail: laura.grigoletti@univr.it
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Summary

Aim – To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages. Methods – Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs. Results – Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users. Conclusion – It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

Keywords

mental health servicesfinancial managementeconomic modelsdecision support techniques
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 19 , Issue 2 , June 2010 , pp. 168 - 177
Copyright
Copyright © Cambridge University Press 2010

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