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

Author:

Neumann Anne,Schmitt Jochen,Seifert Martin,Kliemt Roman,March Stefanie,Häckl Dennis,Swart Enno,Pfennig Andrea,Baum Fabian

Abstract

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).

Funder

More than 70 German statutory health insurance funds

Technische Universität Dresden

Publisher

Springer Science and Business Media LLC

Reference53 articles.

1. Thornicroft G, Tansella M. Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. Br J Psychiatry. 2004;185:283–90.

2. Salize HJ, Rossler W, Becker T. Mental health care in Germany: current state and trends. Eur Arch Psychiatry Clin Neurosci. 2007;257(2):92–103.

3. Busse R, Blumel M, Knieps F, Barnighausen T. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. Lancet. 2017;390(10097):882–97.

4. Nolting HD, Hackmann T. Bestandsaufnahme Von Komplexen Lokalen, regionalen und überregionalen sektorübergreifenden Modellprojekten Zur Versorgung Von Menschen Mit Psychischen Erkrankungen - Abschlussbericht [Inventory of complex local, regional and supra-regional cross-sectoral model projects for the care of people with mental illnesses - final report]. Berlin: IGES Institut GmbH; 2012.

5. Wasem J, Reifferscheid A, Südmersen C, Faßbender R, Thomas D. Das pauschalierende Entgeltsystem für psychiatrische und psychosomatische Einrichtungen: Prüfung der Eignung alternativer Abrechnungseinheiten gemäß dem gesetzlichen Prüfauftrag nach § 17d Abs. 1 S. 2 KHG [The flat-rate remuneration system for psychiatric and psychosomatic facilities, review of the suitability of alternative billing units in accordance with the statutory review mandate pursuant to Section 17d (I) p. 2 KHG2012], IBES Discussion Paper, No. 195, Universität Duisburg-Essen, Institut für Betriebswirtschaft und Volkswirtschaft (IBES), Essen. 2012. https://www.econstor.eu/bitstream/10419/66142/1/729473201.pdf. Accessed 11 Jan 2024.

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