UPBEAT

The Impact of a Psychogeriatric Intervention in VA Medical Centers

Gerald Kominski, Ronald Andersen, Roshan Bastani, Robert Gould, Charles Hackman, David Huang, Lissy Jarvik, Annette Maxwell, Jennifer Moye, Edwin Olsen, Robert Rohrbaugh, Joel Rosansky, Shane Taylor, William Van Stone

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

BACKGROUND. The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. OBJECTIVES. To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. DESIGN. Randomized trial. SUBJECTS. Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). MEASURES. The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. RESULTS. Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069). CONCLUSIONS. UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.

Original languageEnglish
Pages (from-to)500-512
Number of pages13
JournalMedical Care
Volume39
Issue number5
DOIs
StatePublished - May 1 2001
Externally publishedYes

Fingerprint

Geriatric Psychiatry
Inpatients
Mental Health
Ambulatory Care
mental health
evaluation
savings
Costs and Cost Analysis
Veterans
costs
Health Status
health status
Psychiatry
Therapeutics
Anxiety
alcohol
Depression
anxiety
outpatient care
day care

Keywords

  • Comorbid conditions
  • Costs
  • Mental health
  • Veterans

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Kominski, G., Andersen, R., Bastani, R., Gould, R., Hackman, C., Huang, D., ... Van Stone, W. (2001). UPBEAT: The Impact of a Psychogeriatric Intervention in VA Medical Centers. Medical Care, 39(5), 500-512. https://doi.org/10.1097/00005650-200105000-00010

UPBEAT : The Impact of a Psychogeriatric Intervention in VA Medical Centers. / Kominski, Gerald; Andersen, Ronald; Bastani, Roshan; Gould, Robert; Hackman, Charles; Huang, David; Jarvik, Lissy; Maxwell, Annette; Moye, Jennifer; Olsen, Edwin; Rohrbaugh, Robert; Rosansky, Joel; Taylor, Shane; Van Stone, William.

In: Medical Care, Vol. 39, No. 5, 01.05.2001, p. 500-512.

Research output: Contribution to journalArticle

Kominski, G, Andersen, R, Bastani, R, Gould, R, Hackman, C, Huang, D, Jarvik, L, Maxwell, A, Moye, J, Olsen, E, Rohrbaugh, R, Rosansky, J, Taylor, S & Van Stone, W 2001, 'UPBEAT: The Impact of a Psychogeriatric Intervention in VA Medical Centers', Medical Care, vol. 39, no. 5, pp. 500-512. https://doi.org/10.1097/00005650-200105000-00010
Kominski G, Andersen R, Bastani R, Gould R, Hackman C, Huang D et al. UPBEAT: The Impact of a Psychogeriatric Intervention in VA Medical Centers. Medical Care. 2001 May 1;39(5):500-512. https://doi.org/10.1097/00005650-200105000-00010
Kominski, Gerald ; Andersen, Ronald ; Bastani, Roshan ; Gould, Robert ; Hackman, Charles ; Huang, David ; Jarvik, Lissy ; Maxwell, Annette ; Moye, Jennifer ; Olsen, Edwin ; Rohrbaugh, Robert ; Rosansky, Joel ; Taylor, Shane ; Van Stone, William. / UPBEAT : The Impact of a Psychogeriatric Intervention in VA Medical Centers. In: Medical Care. 2001 ; Vol. 39, No. 5. pp. 500-512.
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