• health system research;
  • mental illness;
  • overlapping staff;
  • peer support;
  • Peplau;
  • transitional discharge model

The objective of this study was to determine the cost and effectiveness of a transitional discharge model (TDM) of care with clients who have a chronic mental illness. The model was tested in a randomized clinical trial using a cluster design. This model consisted of: (1) Peer support for 1 year and (2) Ongoing support from hospital staff until a therapeutic relationship was established with the community care provider. Participants (n = 390) were interviewed at discharge, 1 month post-discharge, 6 months post-discharge and 1 year post-discharge. Data collected included demographics, quality of life, health care utilization, levels of functioning and the degree of intervention received. The intervention group post-discharge costs and quality of life were not significantly improved compared with the control group. Although not predicted a priori, intervention subjects were discharged an average of 116 days earlier per person. Based on the hospital per diem rate this would be equivalent to $12M CDN hospital costs. Both under-implementation among implementation wards and contamination in control wards were found. This study demonstrates some of the multiple challenges in health system research.