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Researchers from NewYork-Presbyterian/Columbia University Medical Center (CUMC) have found that incorporating psychiatrists and social workers into the medical team for hospitalized patients dramatically reduced length of stay (LOS) and costs.

The paper was published in the May/June issue of Psychosomatics. The paper has also been published on the Journal’s website.

After the first year, the co-managed care quality initiative saved a total of 2,889 hospital patient days. Analysis of the study was limited to patients with LOS of 10 days or less.

In the co-managed care model, the psychiatrist is a member of the medical team and attends daily weekday teaching rounds with the full team. The psychiatrist is readily able to observe patients’ behaviors, detect symptoms, suggest diagnoses and provide immediate treatment.

This quality improvement program used the co-managed care model in order to more easily identify patients with comorbid medical and psychiatric disorders at NewYork-Presbyterian/CUMC. The program was studied for three years. Using philanthropic funding, the hospital hired a psychiatrist to work with the other members of the medical team, led by Dr. Paul Lee, medical director of the Hospitalist Program at NewYork-Presbyterian/Columbia University Medical Center, to establish new treatment programs, reduce the number of untreated psychiatric disorders/needs, improve patient satisfaction and reduce LOS.

“Inadequate attention to patients’ emotional and psychological needs while they are hospitalized can jeopardize the welfare of patients, which can lead to re-hospitalization, further increasing length of stay and hospital expenditures,” said Dr. Philip R. Muskin, chief of consultation-liaison psychiatry at NewYork-Presbyterian/Columbia University Medical Center, professor of psychiatry at CUMC and senior author of this paper. “By adding a psychiatrist to the medical team, we improved the evaluation and treatment of patients while reducing length of stay. Overall, we were extremely pleased with our results.”

In the 1930s, some general hospitals used consultation-liaison (C-L) psychiatrists to evaluate patients and make recommendations at the request of a patient’s primary physician. More recently, an innovation of collaborative mental health care in inpatient and ambulatory medical services has been embraced by health care systems with great benefits in patient care and cost efficiency. As described in their paper, the co-managed care model allows psychiatrists to serve as a full member of the medical team, allowing them to regularly observe patients’ behaviors and provide immediate treatment when necessary. Dr. Jeffrey Lieberman, chair of psychiatry at NewYork-Presbyterian/Columbia University Medical Center commented that “the proven value of collaborative mental and medical care speaks to its adoption as a standard for health services.”

After one year, calculations revealed that the program successfully reduced LOS for patients compared to the traditional C-L model. The program also reduced ‘lost days,’ which are the days spent in the hospital beyond the expected LOS that are often not covered by insurance. Additionally, the researchers found that the co-managed care model resulted in the following:

• Approximately 1.19 fewer days in the hospital per patient;
• Seeing patients earlier in their hospital stays;
• A decrease in the percentage of patients with LOS of five days or greater, from 59 percent to 34 percent; and
• A decrease in the percentage of patients discharged to psychiatric units, from 15 percent to 9 percent, and an increase in the number of patients discharged home, from 35 percent to 51 percent.

After a successful first year, the CUMC Department of Medicine added a second full-time psychiatrist, a half-time psychiatrist and a full-time social worker to the program.

“These were crucial findings and helped validate the program immensely. The more money you save equals the more money you have to invest in patient care,” said Dr. Muskin. “We believe that co-managed care models like this one can have tremendous impact on the patient care experience and will rejuvenate the traditional consultation-liaison model.”

Co-authors of the paper were Dr. Anne Skomorowsky, psychiatrist at NewYork-Presbyterian and assistant professor of psychiatry at CUMC, and Dr. Ravi N. Shah, postdoctoral residency fellow in the Department of Psychiatry at CUMC.

The authors report no financial or other conflicts of interest. The study was funded and supported by a philanthropic donation from the Barbara and Donald Jonas Foundation, intended to improve the integration of inpatient medical and psychosocial services for an underserved population. The initial three-year donation was matched by Columbia University Department of Medicine internal funds.

NewYork-Presbyterian/Columbia University Medical Center

NewYork-Presbyterian/Columbia University Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Columbia University College of Physicians and Surgeons. NewYork-Presbyterian/Columbia provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian also comprises NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, NewYork-Presbyterian Hospital/Westchester Division, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian/Lower Manhattan Hospital. The hospital is also closely affiliated with NewYork-Presbyterian/Hudson Valley Hospital, NewYork-Presbyterian/Lawrence Hospital and NewYork-Presbyterian/Queens. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area, according to U.S. News & World Report, and consistently named to the magazine’s Honor Roll of best hospitals in the nation. For more information, visit www.nyp.org

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.