Nationwide Uniform Scientific Evaluation of Flexible and Integrated Treatment Projects From 2022 Onwards

Duration of day care psychiatric treatment

Days with day care stays of each included patient will be marked within the patient-individual follow-up period. A billing matrix defining the type of charge and describing the count will be used to mark days with day care stays. Day care stays that range outside the patient-specific follow-up time will be censored. The proportion of patients with at least one day care stay will be presented. Furthermore, the days of day care stays per patient will be added, including the stay that led to inclusion in the evaluation. The classification into inpatient and day care is based on the corresponding charges. If inpatient and day care cases are billed on one day in one hospital, this day will be counted as an inpatient day. It will be analyzed how long patients were treated in hospitals (here only day care stays), summed over the entire observation period for each case (all patients).

Time frame: one year prior to recruitment compared to first to max year after recruitment

Outpatient psychiatric treatment (within and outside the hospital)

The number of days with a contact in the psychiatric outpatients departments (PIA) and with outpatient treatment due to any psychiatric treatment of patients treated in the IG and CG will be recorded and compared.

Time frame: one year prior to recruitment compared to first to max year after recruitment

Continuity of care

It will be analyzed how many cases had at least one contact with the outpatient sector after hospital discharge. A distinction will be made between the outpatient sector in the hospital (PIA) and the outpatient sector outside the hospital (contracted medical sector). In addition, the area of continuity of treatment in the "psychiatric sector" (PIA, physician for psychiatry or child and adolescent psychiatry or psychotherapist) will be summarized.

Time frame: one year prior to recruitment compared to first to max year after recruitment

Inpatient hospital readmission

The proportion of persons with an inpatient stay who were readmitted as inpatients within one year after discharge from the hospital and the days between first inpatient discharge and second inpatient treatment will be examined. The follow-up period is determined on a patient-specific basis. For this purpose, the first discharge date from an inpatient stay in the reference hospital (IG or CG) after inclusion into the evaluation that allowed a one-year follow-up period will be taken as the basis. Readmission is given if the patient had a hospital stay with any psychiatric diagnosis as main diagnosis and was readmitted with a psychiatric diagnosis as main diagnosis within one year.

Time frame: one year prior to one year after first full inpatient psychiatric discharge after recruitment

Discontinuation of contacts for severely mentally ill patients within the psychiatric care system

The frequency of severely mentally ill patients with no contact to the psychiatric care system within 90 and 180 days will be investigated.

Time frame: one year prior to one year after recruitment

Hopping

The percentage of patients with more than three different service providers within the same care sector will be investigated.

Time frame: one year prior to recruitment compared to first to max year after recruitment

Comorbidities

The number of comorbidities will be determined for each patient within the follow-up period and compared between IG and CG. Comorbidities are defined based on the diagnoses of the Elixhauser Score, the diagnosis groups are added unweighted in the context of this analysis.

Time frame: one year prior to recruitment compared to first to max year after recruitment

Mortality

The proportion of individuals who die within a defined period of time after inclusion in the evaluation will be analyzed.

Time frame: event time analysis

Disease progression

The proportion of patients who transition from F32.0 or F32.1 (mild/moderate depressive episode) to F32.2 or F32.3 (severe depressive episode) or from F32 (depressive episode) to F33 (recurrent depressive disorder) or from no addictive disorder (F10-F19) to any additive disorder (F10-F19) will be recorded.

Time frame: event time analysis

Direct medical care costs

The difference in the costs for the treatment of mental illnesses arising between IG and CG during the observation period will be analyzed. In addition, somatic costs will be estimated. For this purpose, the care costs of the following areas will be taken into account: costs of inpatient and day care, cost of outpatient care in hospitals, costs of SHI-accredited medical care, drug costs and remedies costs.

Time frame: one year prior to recruitment compared to first to max year after recruitment

Cost-effectiveness (direct medical costs)

To compare the efficiency of the model project with standard care, a cost-effectiveness analysis will be performed taking a SHI-funds perspective. The incremental cost-effectiveness ratio will be determined using the primary outcome parameter cumulative duration of inpatient stays as the effect measure.

Time frame: one year prior to recruitment compared to first to max year after recruitment