Cost-effectiveness of specialized psychological programs for reducing hospital stays and outpatient visits.

Four naturalistic time-series studies contrasted adult male patients' use of hospital and clinic resources before and after their involvement in psychologist-directed programs of stress management, pain control, vocational rehabilitation, and coping skill training. Six months after biofeedback training, utilization rates for hospital days and clinic visits dropped 72% and 63%, respectively. One-year follow-ups showed that graduates of two vocational rehabilitation programs had reduced hospital days by 81 to 89% and clinic visits by 23 to 41%. After 1 year, graduates of an inpatient chronic pain program reduced former levels of hospital and clinic utilization by 72% and 50%, respectively. Three years later, hospital days of former pain patients remained 47% less than pretreatment, while clinic visits rose to pretreatment levels. Estimated medical cost-offsets from the four programs exceeded $7 million.