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Measuring Safety: A New Perspective on Outcomes of a Long-term Intensive Case Management Program.


In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors.


Advances in Patient Safety: From Research to Implementation (Volume 1: Research Findings). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.


Patient safety is a critical dimension of program effectiveness. Measuring patient safety in managed behavioral health care contexts presents challenges, partly due to the lack of well-defined safety measures. A new perspective on measuring patient safety within the context of a managed behavioral health care intensive case management (ICM) program serving a high-risk population from 16 States in the middle and western United States is presented. Objectives: Investigate the usefulness of community tenure; inpatient utilization and length of stay; functional health status; and patient satisfaction as a constellation of patient safety indicators in an intensive case-management program. Methods: Claims and self-report data 12 months before entry into ICM were compared with matched data 12 months after discharge from ICM, and with comparison group data. Participants were safety-sensitive, with high suicide risk and psychiatric, substance use, and medical comorbidity. Results: Safety was enhanced for the ICM group as measured by 18 percent fewer inpatient days and 17 percent shorter length of stay; 21 percent longer community tenure between admissions, and improved functional health status. Total cost of care was lower for ICM than comparison group. Conclusions: The constellation of measures forms an acceptable indicator of patient safety; results support that ICM enhanced patient safety, preserved patient satisfaction, and reduced cost.

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