Abstract
Importance Psychiatric hospitalization is a major driver of cost in the treatment of schizophrenia. Symptom relapses are a frequent cause of hospitalization and both are primary source of burden to patients and their supporters.
Objective To determine whether a novel, multicomponent, and technology-enhanced approach to relapse prevention in outpatients following a psychiatric hospitalization could reduce days spent in a hospital after discharge.
Design The Improving Care and Reducing Cost (ICRC) study was a quasi-experimental clinical trial in outpatients with schizophrenia conducted between February 2013 and April 2015 at 10 different sites in the US. Data were obtained from 89 participants who received usual relapse prevention services, followed by a second cohort of 349 participants who received the technology-enhanced relapse prevention program. Both groups were followed for 6 months.
Setting Outpatient setting.
Participants Patients were between 18 and 60 years old; had a diagnosis of schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified; and were currently hospitalized or had been hospitalized within the past 30 days.
Intervention Patients received usual care or a technology-enhanced relapse prevention program during a 6-month period after discharge.
Main Outcome(s) and Measure(s) Days spent in a psychiatric hospital during 6 months after discharge.
Results The study included 438 patients. Control participants (N = 89; 37 females) were enrolled first and received usual care for relapse prevention, and followed by 349 participants (128 females) who received technology-enhanced relapse prevention. Days of hospitalization were reduced by 4 days (Mean days: b = −4.25, 95% CI: −8.29; −0.21, P = 0.039) during follow-up in the intervention condition compared to control.
Conclusions and Relevance The reduction in days spent in the hospital for participants in the technology-informed relapse prevention program compared to those who received usual care, and the previously reported high satisfaction and usability suggest that technology-enhanced relapse prevention is an effective and feasible way to reduce rehospitalization days among patients with schizophrenia.
Question Can rehospitalizations in schizophrenia be prevented at reduced cost by innovative mobile technology-delivered interventions?
Findings In this clinical trial with 438 patients, a technology-enhanced relapse prevention program compared to usual services reduced an average of four days of hospitalization per patient during the first 6 months following an index hospitalization.
Meaning Relapse prevention through a health technology may improve care while reducing costs associated with hospitalization.
Footnotes
↵† Equal contribution
Author affiliations updated