Impact of a day hospital facility on type and length of hospital stay: a cost-effectiveness analysis

We evaluated whether participation in rehabilitation activities carried out at the Community Mental Health Center (CMHC) of Castelfranco Emilia (Modena, Italy) is associated with an improvement in relevant clinical outcomes measures. Also, we performed a cost-effectiveness analysis to estimate any reduction in admission costs related to the intervention.d female patients, aged ≥18, from the caseload ofthe CMHC of Castelfranco Emilia. The study was approved by the Local Ethical Committee of the Province of Modena and by the Local Health Agency of Modena. The sample was divided into two groups. The firstgroup was made up of patients attending the day hospital facility between January 1, 2008 and December 31, 2017. This group was compared with a non-experimental control group, made up of patients that did not attend the day hospital facility in the same period. Statistical analysis was performed by means of linear and logistic regressions, both univariate and multivariate. Also, Student’s t-test and Wilcoxon-Mann-Whitney’s Test were used, when appropriate.The sample was made up of 126 users (women: 57%),61 attending and 65 not attending the day hospital facility. Mean age was 49±14 years. The most common diagnoses were schizophrenic spectrum disorders (57%) and mood disorders (20%). The statistical analysis showed a reduction in the number of admissions in patients who attended the day hospital facility (z=2.79, P<0.01). By comparing attending and not attending patients, increased odds of voluntary admissions were noticeable among the former at the 10% significance level (OR=2.49, P=0.07). Compulsory admissions were more common in the control group rather than among patients attending the day hospital facility (38% vs. 19%, P=0.05). Also, though not confirmed at the multiple regression analysis, a trend towards an increase of the use of non-scheduled interventions and a reduction in the number of days as inpatients were noticeable among patients attending the day hospital facility. As far as the cost-effectiveness analysis is concerned, the estimated reduction in hospitalization costs was € 56.135 over 10 years