Yale Bulletin and Calendar

March 2, 2001

Volume 29, Number 21

Two-Week Issue

Shortened hospital stays do not affect
recovery of PTSD patients, says report

When Veteran's Administration (VA) hospitals cut inpatient psychiatric care, there is no overall reduction in effective care and clinical outcomes for post-traumatic stress disorder (PTSD) patients, Yale researchers report in the Feb. 15 issue of Medical Care.

"We found no loss of overall effectiveness at programs that shortened their average length of stay," says Robert Rosenheck, professor in the Departments of Psychiatry and of Epidemiology and Public Health. "But the programs that shifted from a hospital-based program to a low-cost residential rehabilitation program did show some decreased effectiveness. This problem might not lie with the residential model, but with the shift from the hospital setting. The staff might have had to make adjustments in service delivery."

Rosenheck looked at the consequences of reducing beds by evaluating detailed clinical outcomes on 6,397 veterans treated between 1993 and 2000 at 35 specialized VA inpatient and residential programs for PTSD. As controls, Rosenheck also included a set of in-patient and rehabilitation programs that didn't change at all.

"The reduction in length of stay seems to have had no adverse effect on program effectiveness," says Rosenheck, who is also director of the VA's Northeast Program Evaluation Center. "In contrast, programs that shifted from an inpatient to a residential model were less effective, especially in the areas of substance abuse and violent behavior."

The most consistent change affecting the American health care system in the last decade, contends Rosenheck, is the reduction in the availability of inpatient hospital care. "This is especially true in the area of mental health, where there have been reductions of between 30 and 60 percent in in-patient services," he says.

Like the rest of American health care, the Department of Veterans Affairs has undergone tumultuous change, Rosenheck says, especially in the move away from hospital-based care. Rosenheck has been studying the impact of this on mental health patients for the past five years. His past research has examined the specific effects of these changes in veterans treated for PTSD, most of whom served in the Vietnam War.

Rosenheck's collaborator on the study was Alan Fontana, research scientist in psychiatry at Yale and in the Northeast Program Evaluation Center at the VA Connecticut Healthcare System.

-- By Karen Peart

Other Medical Center stories in this issue

Study shows cocaine can harm brain permanently

Clinic eliminating pain of medical procedures for children

Study: Nurses rarely refer patients to hospice care

British and Yale surgeons to share meeting of the minds

T H I SW E E K ' SS T O R I E S

Study shows cocaine can harm brain permanently

Forums explore democracy on local level

Director Spike Lee slams 'same old' black stereotypes in today's films

Head of NFL explains the economics of running a football league

Brooks appointed to Sterling Professor of French and Comparative Literature

Nordhaus is Sterling Professor of Economics

YCIAS awarded Carnegie grant to support study of globalization

MEDICAL CENTER NEWS