Schwarz Julian, Ignatyev Yuriy, Baum Fabian, Neumann Anne, Soltmann Bettina, Pfennig Andrea, Timm Jürgen, Heinze Martin, von Peter Sebastian
Immanuel Klinik Rüdersdorf, Hochschulklinik für Psychiatrie und Psychotherapie der Medizinischen Hochschule Brandenburg, Seebad 82/83, 15562, Rüdersdorf, Deutschland.
Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland.
Nervenarzt. 2022 May;93(5):476-482. doi: 10.1007/s00115-021-01238-2. Epub 2021 Dec 7.
Since 2003 a new remuneration and care model has been implemented in currently 22 psychiatric clinics in Germany, which provides flexible and integrative treatment (FIT) across different settings of treatment, including assertive outreach care. The FIT is based on a global treatment budget covering costs for all psychiatric hospital services and is related to the number of patients treated per year. Previous research identified 11 program components that describe treatment structures and processes of FIT. The present analysis quantitatively compared FIT with standard care, aiming to validate these components.
As part of the PsychCare study, grading according to FIT-specific components was carried out and comparatively analyzed in nine hospitals that used FIT and seven hospitals of standard care. The FIT models were examined in depth in subgroups, which were divided according to the share of the FIT model in the total hospital budget.
Of the 11 FIT program components 7 (flexible care management across settings, therapeutic group sessions across all settings, outreach home care, involvement of informal caregivers, accessibility of services, cooperation across sectors and expansion of professional expertise) showed a high statistical differentiation. These differences were even stronger in the subgroup of those hospitals that had a model contract with all health insurers.
Specific components of FIT are suitable for evaluating the quality of implementation of intersectoral, flexible and outreach psychiatric care.
自2003年以来，德国目前有22家精神病诊所实施了一种新的薪酬和护理模式，该模式在不同治疗环境中提供灵活综合治疗（FIT），包括积极外展护理。FIT基于涵盖所有精神病医院服务成本的全球治疗预算，并与每年治疗的患者数量相关。先前的研究确定了11个描述FIT治疗结构和过程的项目组成部分。本分析对FIT与标准护理进行了定量比较，旨在验证这些组成部分。
作为心理护理研究的一部分，在采用FIT的9家医院和7家标准护理医院中，根据FIT特定组成部分进行分级并进行比较分析。根据FIT模式在医院总预算中的占比，对亚组中的FIT模式进行了深入研究。
在11个FIT项目组成部分中，有7个（跨环境的灵活护理管理、所有环境中的治疗小组会议、外展家庭护理、非正式护理人员的参与、服务的可及性、跨部门合作和专业知识扩展）显示出高度的统计学差异。在与所有健康保险公司签订了示范合同的医院亚组中，这些差异更为明显。
FIT的特定组成部分适用于评估跨部门、灵活和外展精神科护理的实施质量。
