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Research article

Effectiveness of cross-sectoral treatment models for patients with mental disorders - meta-analysis of 13 controlled studies from Germany

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

Abstract

Background

Individuals with mental disorders demand for a continuous and efficient collaboration between different sectors of care. In 2012, a new law in Germany enabled the implementation of cross-sectoral and patient-centered treatment models in psychiatry (FIT64b). These projects have been evaluated by a scientific consortium in controlled cohort studies. We present results of effectiveness based on a meta-analysis from 13 FIT64b hospitals.

Methods/Design

We undertook a series of claims-data-based controlled cohort studies. Data from over 70 statutory health insurance (SHI) funds in Germany were analyzed. All patients insured by any of the participating SHI funds and treated in one of the FIT64b hospitals for any of 16 pre-defined mental disorders were compared with matched control patients from routine care. The collective was subdivided into hospital-new and hospital-known patients. Primary outcomes were duration of inpatient care and duration of sick leave. Individual treatment effects of the 13 FIT64b hospitals were pooled in a random-effects meta-analysis. Meta-regression analysis was used to explore potential reasons for heterogeneity in model effectiveness.

Results

Meta-analyses indicated a significant effect of a reduction by over 5 days on the cumulated duration of inpatient care in hospital-new intervention (IG) compared to control patients (CG). This effect was even stronger among FIT64b hospitals with a pre-existing FIT64b-like environment. Regarding the duration of sick leave there was no overall significant effect between the two groups. Further meta-regression for hospital-new patients revealed that sick leave duration was significantly reduced by almost 13 days in intervention hospitals with a pre-existing FIT64b-like contract compared to hospitals without such a contract.

Conclusions

This meta-analysis suggests positive effects of FIT64b for patients with mental disorders with shorter duration of inpatient treatment. We additionally found a trend towards a reduced duration of sick leave days in FIT64b hospitals with a pre-existing FIT64b–like structure in the pre period. Pre-existing FIT64b-like contracts appear to have facilitated the transition into the new treatment environment. The results should still be interpreted with caution, as this manuscript only covers the first year of the five-year evaluation period in thirteen of eighteen FIT64b hospitals.

Keywords
claims data, psychiatric health care, effectiveness, statutory health insurance, inpatient and outpatient treatment, setting approach, health care system, health services research

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Preprint: Please note that this article has not completed peer review.
Research article

Effectiveness of cross-sectoral treatment models for patients with mental disorders - meta-analysis of 13 controlled studies from Germany

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

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Abstract

Background

Individuals with mental disorders demand for a continuous and efficient collaboration between different sectors of care. In 2012, a new law in Germany enabled the implementation of cross-sectoral and patient-centered treatment models in psychiatry (FIT64b). These projects have been evaluated by a scientific consortium in controlled cohort studies. We present results of effectiveness based on a meta-analysis from 13 FIT64b hospitals.

Methods/Design

We undertook a series of claims-data-based controlled cohort studies. Data from over 70 statutory health insurance (SHI) funds in Germany were analyzed. All patients insured by any of the participating SHI funds and treated in one of the FIT64b hospitals for any of 16 pre-defined mental disorders were compared with matched control patients from routine care. The collective was subdivided into hospital-new and hospital-known patients. Primary outcomes were duration of inpatient care and duration of sick leave. Individual treatment effects of the 13 FIT64b hospitals were pooled in a random-effects meta-analysis. Meta-regression analysis was used to explore potential reasons for heterogeneity in model effectiveness.

Results

Meta-analyses indicated a significant effect of a reduction by over 5 days on the cumulated duration of inpatient care in hospital-new intervention (IG) compared to control patients (CG). This effect was even stronger among FIT64b hospitals with a pre-existing FIT64b-like environment. Regarding the duration of sick leave there was no overall significant effect between the two groups. Further meta-regression for hospital-new patients revealed that sick leave duration was significantly reduced by almost 13 days in intervention hospitals with a pre-existing FIT64b-like contract compared to hospitals without such a contract.

Conclusions

This meta-analysis suggests positive effects of FIT64b for patients with mental disorders with shorter duration of inpatient treatment. We additionally found a trend towards a reduced duration of sick leave days in FIT64b hospitals with a pre-existing FIT64b–like structure in the pre period. Pre-existing FIT64b-like contracts appear to have facilitated the transition into the new treatment environment. The results should still be interpreted with caution, as this manuscript only covers the first year of the five-year evaluation period in thirteen of eighteen FIT64b hospitals.

Figures

Background

Methods

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Tables

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