Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.
Medical Faculty, Universidad Diego Portales, Santiago, Chile.
Int J Geriatr Psychiatry. 2019 Nov;34(11):1557-1564. doi: 10.1002/gps.5165. Epub 2019 Jul 15.
Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects.
A secondary data analysis was conducted using administrative data from eight German mental health centres providing FIT64b. The effects of gender, age, type of centre, and main diagnosis on AHLS were calculated for all older patients with age 65 years or older (n = 3495) treated in FIT64b in the year 2016. Data were analysed with descriptive statistics and robust multiway procedures.
The AHLS of older people with mental illness was 4.8 (SD = 11.5) days. The AHLS was shorter in centres exclusively providing FIT64b than in centres providing FIT64b alongside with standard health care: 3.2 (SD = 6.4) vs 8.4 (SD = 17.8) days, P = .001. This difference was particularly marked among patients with schizophrenia spectrum disorders, mood disorders, and neurotic, stress-related, and somatoform disorders.
FIT64b relates to very short AHLS even among older people. Centres using FIT64b alongside with standard health care usually provide standard care to most patients, which could lead to lower fidelity in the implementation of FIT64b.
自 2012 年以来，一项新法律（《社会法典》第五卷第 64b 条[SGB V]）规范了德国灵活综合精神病治疗项目（FIT64b）的实施。FIT64b 允许患者从住院治疗快速转为门诊治疗，并降低住院费用。一些精神病中心专门提供 FIT64b；其他中心则在提供标准医疗服务的同时提供 FIT64b。本研究的目的是评估纳入 FIT64b 项目的老年精神病患者的平均住院时间（AHLS）。
利用 8 家提供 FIT64b 的德国精神卫生中心的行政数据进行二次数据分析。对 2016 年所有年龄在 65 岁及以上、接受 FIT64b 治疗的老年患者（n = 3495）的性别、年龄、中心类型和主要诊断对 AHLS 的影响进行了计算。采用描述性统计和稳健多向程序进行数据分析。
精神病老年患者的 AHLS 为 4.8（SD = 11.5）天。专门提供 FIT64b 的中心的 AHLS 短于同时提供 FIT64b 和标准医疗保健的中心：3.2（SD = 6.4）与 8.4（SD = 17.8）天，P =.001。在精神分裂症谱系障碍、心境障碍以及神经症性、应激相关和躯体形式障碍患者中，这种差异更为显著。
即使在老年人中，FIT64b 也与非常短的 AHLS 相关。同时使用 FIT64b 和标准医疗保健的中心通常会为大多数患者提供标准护理，这可能导致 FIT64b 的实施保真度降低。
