Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Institute of Social Medicine and Health Economics, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany.
BMC Psychiatry. 2018 May 18;18(1):139. doi: 10.1186/s12888-018-1721-z.
Close, continuous and efficient collaboration between different professions and sectors of care is necessary to provide patient-centered care for individuals with mental disorders. The lack of structured collaboration between in- and outpatient care constitutes a limitation of the German health care system. Since 2012, a new law in Germany (§64b Social code book (SGB) V) has enabled the establishment of cross-sectoral and patient-centered treatment models in psychiatry. Such model projects follow a capitation budget, i.e. a total per patient budget of inpatient and outpatient care in psychiatric clinics. Providers are able to choose the treatment form and adapt the treatment to the needs of the patients. The present study (EVA64) will investigate the effectiveness, costs and efficiency of almost all model projects established in Germany between 2013 and 2016.
METHODS/DESIGN: A health insurance data-based controlled cohort study is used. Data from up to 89 statutory health insurance (SHI) funds, i.e. 79% of all SHI funds in Germany (May 2017), on inpatient and outpatient care, pharmaceutical and non-pharmaceutical treatments and sick leave for a period of 7 years will be analyzed. All patients insured by any of the participating SHI funds and treated in one of the model hospitals for any of 16 pre-defined mental disorders will be compared with patients in routine care. Sick leave (primary outcome), utilization of inpatient care (primary outcome), utilization of outpatient care, continuity of contacts in (psychiatric) care, physician and hospital hopping, re-admission rate, comorbidity, mortality, disease progression, and guideline adherence will be analyzed. Cost and effectivity of model and routine care will be estimated using cost-effectiveness analyses. Up to 10 control hospitals for each of the 18 model hospitals will be selected according to a pre-defined algorithm.
The evaluation of complex interventions is an important main task of health services research and constitutes the basis of evidence-guided advancement in health care. The study will yield important new evidence to guide the future provision of routine care for mentally ill patients in Germany and possibly beyond.
This study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713 ).
为了为精神障碍患者提供以患者为中心的护理，不同专业和护理领域之间需要密切、持续和高效的合作。门急诊之间缺乏结构化的合作是德国医疗保健系统的一个局限性。自 2012 年以来，德国的一项新法律（§64b 社会法典书（SGB）V）使精神病学领域建立跨部门和以患者为中心的治疗模式成为可能。这种模式项目遵循人头预算，即精神病诊所的住院和门诊护理的每位患者总预算。提供者能够选择治疗形式，并根据患者的需求调整治疗。本研究（EVA64）将调查 2013 年至 2016 年间在德国建立的几乎所有模式项目的有效性、成本和效率。
方法/设计：本研究采用基于健康保险数据的对照队列研究。将分析多达 89 个法定健康保险（SHI）基金的数据，即德国所有 SHI 基金的 79%（2017 年 5 月），包括 7 年的住院和门诊护理、药物和非药物治疗以及病假数据。所有在参与的 SHI 基金之一投保并在 16 种预先确定的精神障碍之一的模式医院接受治疗的患者将与常规护理中的患者进行比较。病假（主要结果）、住院治疗（主要结果）、门诊治疗、（精神科）护理连续性、医生和医院跳槽、再入院率、合并症、死亡率、疾病进展和指南依从性将进行分析。使用成本效益分析来估计模型和常规护理的成本效益。将根据预先定义的算法为每个 18 个模式医院中的每一个选择多达 10 个对照医院。
复杂干预措施的评估是卫生服务研究的一个重要主要任务，也是循证医疗保健进步的基础。该研究将提供重要的新证据，以指导德国乃至未来精神病患者常规护理的提供。
本研究在“德国卫生服务研究”数据库中注册（试验编号：VVfD_EVA64_15_003713）。
