Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
Psychol Med. 2023 Jul;53(9):4114-4120. doi: 10.1017/S0033291722000794. Epub 2022 May 30.
Psychiatric hospitalization is a major driver of cost in the treatment of schizophrenia. Here, we asked whether a technology-enhanced approach to relapse prevention could reduce days spent in a hospital after discharge.
The Improving Care and Reducing Cost (ICRC) study was a quasi-experimental clinical trial in outpatients with schizophrenia conducted between 26 February 2013 and 17 April 2015 at 10 different sites in the USA in an outpatient setting. Patients were between 18 and 60 years old with a diagnosis of schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified. Patients received usual care or a technology-enhanced relapse prevention program during a 6-month period after discharge. The health technology program included in-person, individualized relapse prevention planning with treatments delivered via smartphones and computers, as well as a web-based prescriber decision support program. The main outcome measure was days spent in a psychiatric hospital during 6 months after discharge.
The study included 462 patients, of which 438 had complete baseline data and were thus used for propensity matching and analysis. Control participants ( = 89; 37 females) were enrolled first and received usual care for relapse prevention followed by 349 participants (128 females) who received technology-enhanced relapse prevention. During 6-month follow-up, 43% of control and 24% of intervention participants were hospitalized (χ2 = 11.76, p<0.001). Days of hospitalization were reduced by 5 days (mean days: = -4.58, 95% CI -9.03 to -0.13, = 0.044) in the intervention condition compared to control.
These results suggest that technology-enhanced relapse prevention is an effective and feasible way to reduce rehospitalization days among patients with schizophrenia.
精神科住院是治疗精神分裂症的主要费用驱动因素。在这里，我们询问了一种强化预防复发的方法是否可以减少出院后住院的天数。
改善护理和降低成本（ICRC）研究是 2013 年 2 月 26 日至 2015 年 4 月 17 日在美国 10 个不同地点的门诊环境中进行的一项针对精神分裂症门诊患者的准实验性临床试验。患者年龄在 18 至 60 岁之间，诊断为精神分裂症、分裂情感障碍或未特指的精神病性障碍。患者在出院后 6 个月内接受常规护理或强化预防复发技术方案。该健康技术方案包括面对面、个体化的复发预防计划，通过智能手机和计算机提供治疗，以及基于网络的处方决策支持方案。主要结局测量指标是出院后 6 个月内住院的天数。
该研究纳入了 462 名患者，其中 438 名患者具有完整的基线数据，因此用于倾向匹配和分析。对照组（n = 89；37 名女性）首先入组，接受常规护理预防复发，随后 349 名患者（n = 128 名女性）接受强化预防复发技术方案。在 6 个月的随访期间，对照组和干预组分别有 43%和 24%的患者住院（χ2 = 11.76，p<0.001）。与对照组相比，干预组的住院天数减少了 5 天（平均天数： = -4.58，95%CI -9.03 至 -0.13， = 0.044）。
这些结果表明，强化预防复发技术是减少精神分裂症患者再住院天数的有效且可行的方法。
