Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany.
Transl Psychiatry. 2022 Sep 7;12(1):370. doi: 10.1038/s41398-022-02131-5.
Mental disorders pose a worldwide growing public health burden. One of the major challenges for healthcare systems remains to respond to the need of patients with mental disorders for continuous and flexible treatment. The EVA64 study evaluates novel programs of flexible and integrative treatment (FIT) in hospitals. This manuscript presents results from the evaluation of FIT hospitals in comparison to hospitals from regular routine care. In addition to data from adult patients, we also present data from affiliated child and adolescent psychiatric wards employing FIT programs. Using comprehensive claims data, primary outcomes are the utilization of inpatient care and sick leave for a priori defined clusters of mental disorders. We stratify between patients already under treatment (ongoing treatment) and patients with incident treatment cases (initial treatment) at the point of inclusion in the study. In the initial treatment group, we found a significant reduction in the length of inpatient stay of 4.1 days in FIT hospitals compared to routine care. While patients with mood affective disorders (-1.8 days) and patients with neurotic, stress-related, and somatoform disorders (-3.6 days) showed an even stronger effect of the reduction of inpatient lengths of stay, the effect was significantly weaker in patients with mental and behavioral disorders due to use of alcohol (+3.3 days). Regarding the duration of sick leave, we found no significant treatment effect of FIT programs compared to routine care. In the ongoing treatment group of adult patients, we found a significantly lower utilization of inpatient treatment by 1.3 days as well as a shorter duration of sick leave by 4.3 days in FIT hospitals compared to routine care. In the cohort of children and adolescent patients, we also did not observe a significant treatment effect in either the initial treatment group or the ongoing treatment group. Registration: this study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713).
精神障碍是全球日益严重的公共卫生负担之一。医疗保健系统面临的主要挑战之一仍然是满足精神障碍患者对连续和灵活治疗的需求。EVA64 研究评估了医院中灵活综合治疗（FIT）的新方案。本文介绍了与常规常规护理相比，对 FIT 医院进行评估的结果。除了来自成年患者的数据外，我们还介绍了采用 FIT 方案的附属儿童和青少年精神病病房的数据。使用综合索赔数据，主要结果是预先定义的精神障碍集群的住院治疗和病假的利用。我们在已经接受治疗的患者（正在进行的治疗）和在研究纳入点接受初始治疗的患者（初始治疗）之间进行分层。在初始治疗组中，我们发现 FIT 医院的住院时间缩短了 4.1 天，与常规护理相比。虽然心境情感障碍患者（-1.8 天）和神经症、应激相关和躯体形式障碍患者（-3.6 天）的住院时间缩短效果更强，但由于使用酒精，精神和行为障碍患者的效果明显较弱（+3.3 天）。关于病假持续时间，我们没有发现 FIT 方案与常规护理相比的治疗效果显著。在成年患者的持续治疗组中，我们发现 FIT 医院的住院治疗利用率显著降低 1.3 天，病假持续时间缩短 4.3 天，与常规护理相比。在儿童和青少年患者队列中，我们也没有观察到初始治疗组或持续治疗组的治疗效果显著。注册：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）。
