Department of Reintegration, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Can J Psychiatry. 2011 Mar;56(3):154-60. doi: 10.1177/070674371105600305.
The implementation of assertive community treatment (ACT) varies widely. To date, the association between model fidelity and effect has not been investigated in Europe. We investigated the association between model fidelity and outcome in the Dutch mental health system.
In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams. Patients with severe mental illness (n = 530) participated in the study. Outcomes were assessed 3 times using the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), and the number of hospital days and homeless days during a 2-year follow-up period. Data were analyzed using multilevel statistics.
High ACT model fidelity was associated with better outcomes on the HoNOS and less homeless days. Among all of the ACT ingredients, team structure was associated with better outcomes. No associations were found between ACT model fidelity, number of hospital days, and CANSAS scores.
Our evidence supports the importance of model fidelity for improving patient outcomes.
确保社区治疗（ACT）的实施具有广泛的多样性。迄今为止，在欧洲，尚未研究模型保真度与效果之间的关联。我们调查了荷兰精神卫生系统中模型保真度与结果之间的关联。
在一项前瞻性纵向研究中，我们评估了 20 个门诊治疗团队的 ACT 模型保真度和患者结果。有严重精神疾病的患者（n = 530）参与了这项研究。使用健康国家结局量表（HoNOS）、坎伯韦尔需求评估短期评估量表（CANSAS）以及在 2 年随访期间的住院天数和无家可归天数，在 3 次评估中评估了结果。使用多层次统计数据进行分析。
高 ACT 模型保真度与 HoNOS 上更好的结果和更少的无家可归天数有关。在所有的 ACT 成分中，团队结构与更好的结果有关。ACT 模型保真度、住院天数和 CANSAS 评分之间没有关联。
我们的证据支持了模型保真度对改善患者结果的重要性。
