DETROIT - A quality improvement project developed by Wayne State University School of Medicine researchers and Wayne State University Physician Group clinicians to reduce inpatient psychiatric admissions in area hospitals could save the state's "Healthy Michigan" newly-expanded Medicaid program $7.5 million a year.

Key findings:

• The Face-to-Face Inpatient Diversion Program implemented in 2005 reduced hospitalizations 89 percent for 346 patients in the first 14 weeks of intervention.
• 356 patients ages 20 to 63 were diverted from 16 emergency departments in Wayne, Oakland and Macomb counties. Of those, only four returned in the next 30 days.
• Costs declined 78.7 percent per diverted patient, saving Medicaid up to $623,000 per month.
• Lengths of stay decreased and long-term follow-up showed patients stayed out of the hospital with better health outcomes.
• The program was halted April-July 2013 following a policy review. In that period, 1,355 patients were hospitalized, compared to 795 the same period in 2012.
• Cost during the stoppage was $5.7 million, $2.5 million more than in 2012.

The project, "Intervention to Reduce Inpatient Psychiatric Admission in a Metropolitan City," is detailed in May's Community Mental Health Journal, available here.

The program was developed by Wayne State faculty at WSUPG's Crisis Center inside the Detroit Medical Center's Detroit Receiving Hospital. A team looked at the effectiveness of transporting patients medically certified for psychiatric hospitalization to a central psychiatric emergency service.

Upon arrival, patients were re-evaluated by psychiatrists specially trained in emergency psychiatry and a mental health team to identify the correct diagnosis and any underlying problems, such as unstable co-morbid medical illnesses, substance abuse, non-convulsive seizures and nonverbal patients with developmental disabilities expressing pain through behavior. Staff, including psychiatric nurses and social workers, also assessed patients for acute and chronic bio-psycho-social stressors. Patients who didn't require hospitalization saw a case manager and scheduled an outpatient appointment. Discharged patients were less likely to be readmitted at a later date compared to those who remained hospitalized after the intervention.

"So patients did better, and went back to families, work and society quicker," said David Rosenberg, M.D., Department of Psychiatry and Behavioral Neurosciences professor and chair and the Miriam Hamburger Endowed Chair of Child Psychiatry.

Approximately 4,000 inpatient hospitalizations occur annually in Wayne County alone, according to the study. The average cost for inpatient beds in the study area is $600 per day. Average cost of an ambulance transport is $270, and evaluation and a 23-hour hold is $365. Alternatively, care and beds at crisis-oriented adult foster care homes with nursing and social work support average $140 per day.

The evaluation was supported in part by the state of Michigan's Lycaki-Young Fund, with services funded by the Detroit Wayne Mental Health Authority and Gateway Community Health, a Detroit-funded managed care plan network for more than 17,000 Wayne County residents with acute mental and behavioral health issues.

"We believe Wayne County can serve as a national model for how to implement effective psychiatric care in a high-density Medicaid population. The timing could not be better or more important since Medicaid enrollment has expanded in Michigan significantly," said Robert A. Frank, M.D., WSUPG chief executive officer and chief medical officer.

The study was led by principal investigator Alireza Amirsadri, M.D., the department's chief medical officer.

"The intervention literally saved lives," Dr. Amirsadri said, referring to about 3 percent of study patients presenting with psychosis due to a medical problem. "Our comprehensive assessment revealed that they had delirium with severe underlying medical problems. Some were transferred directly to the medical intensive care unit. Imagine what may have happened had they been admitted to a free-standing inpatient psychiatric hospital without access to ICU equipment and resources."

The study team is now looking at how to improve diagnosis, from better access to care and the use of telemedicine to create technology-based training modules to educate health care workers about psychiatric illnesses.

About Wayne State University School of Medicine

Founded in 1868, the Wayne State University School of Medicine is the largest single-campus medical school in the nation, with more than 1,000 medical students. In addition to undergraduate medical education, the school offers master's degree, doctoral and M.D.-Ph.D. programs in 14 areas of basic science to about 400 students annually. Connect with us on Facebook, Twitter @wsu_med_school and Pinterest.

About Wayne State University Physician Group

Wayne State University Physician Group is the one of the largest nonprofit multi-specialty physician practice groups in southeast Michigan, with more than 2,000 affiliated physicians providing primary and specialty care. As faculty members at the Wayne State University School of Medicine, WSUPG doctors are at the forefront of medical science. To make an appointment at one of our more than 180 locations call 877-WSU-DOCS (877-978-3627) or visit www.upgdocs.org. Connect with WSUPG at www.facebook.com/WSUPGDocs or follow @WSUPGDocs on Twitter.