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Christensen TN, Wallstrøm IG, Stenager E, Hellström L, Bojesen AB, Nordentoft M, Eplov LF. 30-Month Follow-Up of Individual Placement and Support (IPS) and Cognitive Remediation for People with Severe Mental Illness: Results from a Randomized Clinical Trial. PSYCHIATRY JOURNAL 2023; 2023:2789891. [PMID: 37151719 PMCID: PMC10162865 DOI: 10.1155/2023/2789891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/27/2022] [Accepted: 03/21/2023] [Indexed: 05/09/2023]
Abstract
Background The individual placement and support (IPS) model for persons with severe mental illness has proven to be more effective than traditional vocational approaches in improving competitive work over 18 months. In this study, the longer-term effects of IPS over 30 months were investigated in a Danish setting. Method In a randomized clinical trial, we compared the effects of IPS, IPS enhanced with cognitive remediation and work-related social skills training (IPSE), and service as usual (SAU). At three locations in Denmark, 720 patients with serious mental illnesses were randomly assigned to the three groups. Competitive employment, education, and hospital admissions were tracked for 30 months using Danish national registers. Results The beneficial effects of IPS on competitive employment and education at the 18-month follow-up were sustained over the 30-month follow-up period. Participants receiving IPS or IPSE were more likely to obtain competitive employment or education than those who received service as usual (IPS 65%, IPSE 65%, SAU 53%, p = 0.006), and they worked on average more weeks competitively (IPS 25 weeks, IPSE 21 weeks, SAU 17 weeks; IPS vs. SAU p = 0.004 and IPSE vs. SAU p = 0.007). Moreover, participants in the two IPS groups had fewer outpatient visits during the 30-month follow-up. However, this was only statistically significant when comparing IPSE with SAU p = 0.017. Conclusion In conclusion, IPS and IPS enhanced with cognitive remediation and work-related skills training demonstrated that the vocational effects of the interventions are retrained over 30 months in a Danish context.
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Affiliation(s)
- Thomas Nordahl Christensen
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Iben Gammelgård Wallstrøm
- Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lone Hellström
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Bo Bojesen
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
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Jordan N, Stroupe KT, Richman J, Pogoda TK, Cao L, Kertesz S, Kyriakides TC, Bond GR, Davis LL. Comparing Service Use and Costs of Individual Placement and Support With Usual Vocational Services for Veterans With PTSD. Psychiatr Serv 2022; 73:1109-1116. [PMID: 35538744 DOI: 10.1176/appi.ps.202100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Among veterans with posttraumatic stress disorder (PTSD), supported employment that utilizes the individual placement and support (IPS) model has resulted in consistently better employment and functional outcomes than usual vocational rehabilitation services. This study aimed to compare these two approaches in terms of health services use and associated costs. METHODS A secondary analysis of a multisite randomized controlled trial of 541 unemployed veterans with PTSD used archival data from electronic medical records to assess the use and costs of health services of IPS and usual care (i.e., a transitional work [TW] program) over 18 months. Comparisons were also made to an 18-month postintervention period. RESULTS The two study groups did not differ in number of inpatient days or in utilization or cost of high-intensity services. Annual per-person costs of health services were approximately 20% higher for IPS than for TW participants (mean difference=$4,910 per person per year, p<0.05) during the intervention period, largely driven by higher utilization and costs for vocational services in the IPS group (p<0.001). These costs declined postintervention to nonsignificant differences. The mean annual per-person vocational service cost was $6,388 for IPS and $2,549 for TW (mean difference=$3,839, p<0.001) during the intervention period. CONCLUSIONS In keeping with IPS’s intensive case management approach, veterans receiving IPS used more vocational services and had correspondingly higher costs than veterans receiving TW. The two groups did not differ in use or cost of other types of health services. Future research should examine whether higher short-term costs associated with IPS relative to usual care result in long-term cost savings or higher quality of life for persons with PTSD.
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Affiliation(s)
- Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Joshua Richman
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Terri K Pogoda
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Stefan Kertesz
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Tassos C Kyriakides
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Gary R Bond
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lori L Davis
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
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Stroupe KT, Jordan N, Richman J, Bond GR, Pogoda TK, Cao L, Kertesz SG, Kyriakides TC, Davis LL. Cost-Effectiveness of Individual Placement and Support Compared to Transitional Work Program for Veterans with Post-traumatic Stress Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:429-439. [PMID: 34677786 DOI: 10.1007/s10488-021-01173-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) leads to significant disability, unemployment, and substantial healthcare costs. The cost-effectiveness of vocational rehabilitation (VR) interventions is important to consider when determining which services to offer. This study assesses the cost-effectiveness and return on investment of Individual Placement and Support (IPS) compared to transitional work (TW) programs. Employment outcomes from a multisite randomized trial comparing IPS to TW in military veterans with PTSD (n = 541) were linked to Veterans Health Administration (VHA) archival medical record databases to examine the comparative cost-effectiveness and return on investment. Effectiveness was defined as hours worked and income earned in competitive jobs. Costs for VR, mental health, and medical care and income earned from competitive sources were annualized and adjusted to 2019 US dollars. The annualized mean cost per person of outpatient (including vocational services) were $3970 higher for IPS compared to TW ($23,245 vs. $19,276, respectively; P = 0.004). When TW income was included in costs, mean grand total costs per person per year were similar between groups ($29,828 IPS vs. $26,772 TW; P = 0.17). The incremental cost-effectiveness analysis showed that while IPS is more costly, it is also more effective. The return on investment (excluding TW income) was 32.9% for IPS ($9762 mean income/$29,691 mean total costs) and 29.6% for TW ($7326 mean income/$24,781 mean total costs). IPS significantly improves employment outcomes for individuals with PTSD with negligible increase in healthcare costs and yields very good return on investment compared to non-IPS VR services.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA. .,Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua Richman
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Building 9, Office 218, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA
| | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Tassos C Kyriakides
- West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Lori L Davis
- Research and Development Service, Tuscaloosa VA Medical Center-Psychiatry, 3701 Loop Rd, Tuscaloosa, AL, 35404, USA.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham, AL, USA
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