Changes in patient care through flexible and integrated treatment programs in German psychiatric hospitals: meta-analyses based on a series of controlled claims-based cohort studies
Background Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in...
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| Vydáno v: | BMC psychiatry Ročník 24; číslo 1; s. 74 - 17 |
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| Hlavní autoři: | , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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BioMed Central
26.01.2024
BioMed Central Ltd Springer Nature B.V BMC |
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| ISSN: | 1471-244X, 1471-244X |
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| Abstract | Background
Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals.
Methods
We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient’s first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms
group
(FIT hospital vs. routine care) x
time
(year before vs. first or second patient year after study inclusion) in the Poisson models.
Results
The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals.
Conclusions
Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions.
Trial registration
This study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713). |
|---|---|
| AbstractList | BackgroundGlobal treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals.MethodsWe conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient’s first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models.ResultsThe 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals.ConclusionsGlobal treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions.Trial registrationThis study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713). Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals.BACKGROUNDGlobal treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals.We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient's first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models.METHODSWe conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient's first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models.The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals.RESULTSThe 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals.Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions.CONCLUSIONSGlobal treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions.This study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713).TRIAL REGISTRATIONThis study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713). Background Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals. Methods We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient’s first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models. Results The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals. Conclusions Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions. Trial registration This study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713). Background Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals. Methods We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient's first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models. Results The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals. Conclusions Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions. Trial registration This study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713). Keywords: Claims data, Mental health care, Global treatment budget, Inpatient and outpatient treatment, Treatment continuity, FIT hospital Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals. We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient's first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models. The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals. Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions. Abstract Background Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals. Methods We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient’s first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models. Results The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals. Conclusions Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions. Trial registration This study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713). Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals. We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient's first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models. The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals. Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions. This study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713). |
| ArticleNumber | 74 |
| Audience | Academic |
| Author | Seifert, Martin March, Stefanie Baum, Fabian Schmitt, Jochen Swart, Enno Kliemt, Roman Neumann, Anne Häckl, Dennis Pfennig, Andrea |
| Author_xml | – sequence: 1 givenname: Anne surname: Neumann fullname: Neumann, Anne email: Anne.Neumann@uniklinikum-dresden.de organization: Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden – sequence: 2 givenname: Jochen surname: Schmitt fullname: Schmitt, Jochen organization: Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden – sequence: 3 givenname: Martin surname: Seifert fullname: Seifert, Martin organization: Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden – sequence: 4 givenname: Roman surname: Kliemt fullname: Kliemt, Roman organization: WIG2 Scientific Institute for Health Economics and Health System Research Leipzig – sequence: 5 givenname: Stefanie surname: March fullname: March, Stefanie organization: Institute of Social Medicine and Health Services Research, Medical Faculty, Otto-Von-Guericke-University, Department of Social Work, Health and Media, Hochschule Magdeburg-Stendal – sequence: 6 givenname: Dennis surname: Häckl fullname: Häckl, Dennis organization: WIG2 Scientific Institute for Health Economics and Health System Research Leipzig – sequence: 7 givenname: Enno surname: Swart fullname: Swart, Enno organization: Institute of Social Medicine and Health Services Research, Medical Faculty, Otto-Von-Guericke-University – sequence: 8 givenname: Andrea surname: Pfennig fullname: Pfennig, Andrea organization: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden – sequence: 9 givenname: Fabian surname: Baum fullname: Baum, Fabian organization: Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38279112$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1080_09638288_2024_2447376 crossref_primary_10_1055_a_2266_6881 crossref_primary_10_1007_s00115_025_01896_6 crossref_primary_10_1080_09540261_2025_2479601 crossref_primary_10_1007_s11553_025_01249_w |
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| Keywords | Mental health care FIT hospital Claims data Global treatment budget Inpatient and outpatient treatment Treatment continuity |
| Language | English |
| License | 2024. The Author(s). |
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| PublicationTitle | BMC psychiatry |
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| References | M Assheuer (5500_CR8) 2021; 48 J Schwarz (5500_CR24) 2020; 70 5500_CR26 5500_CR5 5500_CR4 E Swart (5500_CR36) 2021 A Deister (5500_CR17) 2010; 37 5500_CR9 A Neumann (5500_CR29) 2021; 48 E Swart (5500_CR41) 2016; 78 R Busse (5500_CR3) 2017; 390 S Indefrey (5500_CR32) 2020; 11 J Schwarz (5500_CR23) 2020; 11 W Viechtbauer (5500_CR44) 2010; 36 HJ Salize (5500_CR2) 2007; 257 C Roick (5500_CR16) 2008; 35 5500_CR22 AS Mueller-Stierlin (5500_CR27) 2017; 17 AS Stierlin (5500_CR12) 2014; 14 HH Konig (5500_CR14) 2010; 37 5500_CR19 5500_CR18 B Schroder (5500_CR21) 2017; 44 M Blumel (5500_CR10) 2020; 22 SJ Ziguras (5500_CR47) 2000; 51 W de Cruppé (5500_CR51) 2023; 23 B Soltmann (5500_CR53) 2021; 12 E Swart (5500_CR40) 2015; 77 Y Ignatyev (5500_CR49) 2019; 34 C Wheeler (5500_CR25) 2015; 15 G Thornicroft (5500_CR1) 2004; 185 5500_CR46 A Neumann (5500_CR52) 2021; 21 R Jacobs (5500_CR20) 2018; 24 W Hoffmann (5500_CR39) 2019; 34 C Roick (5500_CR15) 2005; 32 HH Konig (5500_CR31) 2013; 40 F Afraz (5500_CR7) 2021; 21 PH Falkai (5500_CR43) 2013 P Schmid (5500_CR33) 2013; 40 TA Trikalinos (5500_CR45) 2012; 9 5500_CR37 F Baum (5500_CR30) 2022; 12 5500_CR35 A Deister (5500_CR11) 2004; 30 M Lambert (5500_CR48) 2010; 71 T Petzold (5500_CR38) 2019; 81 F Baum (5500_CR28) 2020; 11 R Kliemt (5500_CR6) 2020 M Schmedders (5500_CR50) 2023; 42 5500_CR34 H Quan (5500_CR42) 2005; 43 M Lambert (5500_CR13) 2014; 41 |
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Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with... Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and... Background Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with... BackgroundGlobal treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with... Abstract Background Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together... |
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| SubjectTerms | Adolescent Adult Ambulatory Care Budgets Care and treatment Child Child & adolescent psychiatry Claims data Cohort analysis Cohort Studies Diagnosis FIT hospital Germany Global treatment budget Health insurance Hospitalization Hospitals Hospitals, Psychiatric Humans Inpatient and outpatient treatment Integrated delivery systems Medicine Medicine & Public Health Mental disorders Mental Disorders - therapy Mental health care Mental illness Patients Psychiatric services Psychiatry Psychotherapy Statistical analysis Treatment continuity |
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| Title | Changes in patient care through flexible and integrated treatment programs in German psychiatric hospitals: meta-analyses based on a series of controlled claims-based cohort studies |
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