Outpatient commitment and its alternatives: questions yet to be answered

This Open Forum reviews research findings on outpatient commitment and alternative approaches, such as conditional hospital release and guardianship. Despite the accumulating evidence in favor of these practices, many questions remain about their essential elements and comparative effectiveness. The authors describe the strengths and shortcomings in existing studies and propose a research strategy that would take advantage of advances in methodologies, such as instrumental variables and propensity weighting, to design studies with a level of rigor comparable to that of randomized controlled trials. The Affordable Care Act (ACA) introduces many opportunities and resources to improve care; studies should also be undertaken to investigate use of outpatient commitment and alternative approaches in the post-ACA health care environment.