CALIFORNIA STATE UNIVERSITY LONG BEACH
PPA 696--RESEARCH METHODS
BINGHAM & FELBINGER CH. 4
  1. BIBLIOGRAPHIC INFORMATION
    1. Author: A. Solberg
    1. Title: Community Post-hospital Follow-up Services
    1. Source: Evaluation Review, 17(1), 1983:96-109

      2.  
  1. SUMMARY OF THE RESEARCH
    1. PROBLEM STATEMENT:
Can community-based follow-up reduce re-hospitalization rates and the cost of mental health care?
    1. BACKGROUND:
Patients discharged from hospitalization for mental health problems have high re-hospitalization rates
    1. HYPOTHESIS:
1) Follow-up services prevent or delay re-hospitalization

2) Follow-up services reduce the cost of mental health care

    1. MEASUREMENT OF VARIABLES
      1. Dependent variable: Re-hospitalization within 60 days
      1. Independent variable(s): Community-based follow-up services
      1. Control variable(s): n/a
    1. RESEARCH DESIGN:
True experimental design using post-test only control group design.
Group Community-based follow-up services T1
G-1 X O1
G-2 O1
 
    1. SAMPLING:
143 people discharged from the Acute Psychiatric unit in Fresno, CA., between May and July 1980.
    1. INSTRUMENTATION:
Hospital records that would indicate whether re-hospitalization had occurred within 60 days
    1. DATA COLLECTION/ETHICS:
1) re-hospitalization rates for the two groups;

2) cost of re-hospitalization

3) cost of the program

4) cost of participation in the program

    1. DATA ANALYSIS:
Techniques of "survival analysis" were applied; the V-statistic showed significant differences in the re-hospitalization rate of the two groups. However, a t-test showed no significant differences in the total costs between the two groups.
    1. CONCLUSIONS:
Community follow-up services reduce re-hospitalizations
 
 
  1. CRITIQUE
    1. Possible Threats to Internal Validity
      1. History:
controlled by control group
      1. Maturation:
not applicable; short duration of study
      1. Testing:
not applicable--no pretest
      1. Instrumentation:
case records and accounting records used; no change over time
      1. Regression Artifact:
controlled by control group; all were equally dysfunctional
      1. Selection bias:
bias controlled by random assignment to experimental and control groups
      1. Experimental Mortality:
Of the 71 experimental group subjects, 17 (24%) were considered drop-outs because they refused to cooperate with the program. The re-hospitalization rate for drop-outs is not known. This may have over-stated the benefits of the program. Also, because there were more people in the control group (72), their total re-hospitalization costs would be higher even if they had the same rate of re-hospitalization as the experimental group.
      1. Design contamination:
Not addressed; not known if any controls experienced exceptional community support.
    1. Possible Threats to External Validity
      1. unique program features:
Requires exceptional efforts to complete follow-ups
      1. experimental arrangements:
n/a; occurred in natural setting
      1. other threats:
Limited applicability to groups outside Fresno