Schwarz Julian, Wolff Jan, Heinze Martin, von Peter Sebastian, Habicht Juri Luis
Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.
Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.
Front Psychiatry. 2023 May 9;14:1166197. doi: 10.3389/fpsyt.2023.1166197. eCollection 2023.
Intensive forms of outreach mental health care (IOC) such as crisis resolution or home treatment teams are increasingly implemented as alternatives to inpatient admission, providing recovery-oriented treatment at home at comparable costs and outcomes. However, one issue with IOC is the lack of continuity regarding staff members who provide home visits, complicating relationship building and meaningful therapeutic exchange. The aim of this study is to validate existing primarily qualitative findings using performance data and to explore a possible correlation between the number of staff involved within IOC treatment and the service users' length of stay (LOS).
Routine data from an IOC team in a catchment area in Eastern Germany were analyzed. Basic parameters of service delivery were calculated and an in-depth descriptive analysis regarding staff continuity was performed. Further, an exploratory single case analysis was conducted, presenting the exact sequence of all treatment contacts for one case with low and one with high staff continuity.
We analyzed 10.598 face-to-face treatment contacts based on 178 IOC users. The mean LOS was 30.99 days. About 75% of all home visits were conducted by two or more staff members simultaneously. Service users saw an average of 10.24 different staff per treatment episode. On 11% of the care days, only unknown staff, and on 34% of the care days at least one unknown staff member conducted the home visit. 83% of the contacts were performed by the same three staff members and 51% were made by one and the same staff member. A significant positive correlation ( = 0.0007) was found between the number of different practitioners seen by a service user in the first seven days of care and the LOS.
Our results suggest that a high number of different staff in the early period of IOC episodes correlates with an extended LOS. Future research must clarify the exact mechanisms of this correlation. Furthermore, it should be investigated how the multiple professions within IOC teams influence the LOS and the quality of treatment and what quality indicators may be suitable to ensure treatment processes.
诸如危机解决或居家治疗团队等强化形式的外展心理健康护理（IOC）越来越多地被用作住院治疗的替代方案，以可比的成本和结果在家中提供以康复为导向的治疗。然而，IOC存在的一个问题是提供家访的工作人员缺乏连续性，这使得建立关系和有意义的治疗交流变得复杂。本研究的目的是使用绩效数据验证现有的主要定性研究结果，并探讨IOC治疗中涉及的工作人员数量与服务使用者住院时间（LOS）之间可能存在的相关性。
对德国东部一个集水区的IOC团队的常规数据进行了分析。计算了服务提供的基本参数，并对工作人员的连续性进行了深入的描述性分析。此外，进行了一项探索性单病例分析，展示了一名工作人员连续性低和一名工作人员连续性高的病例的所有治疗接触的确切顺序。
我们基于178名IOC使用者分析了11,598次面对面治疗接触。平均住院时间为30.99天。所有家访中约75%是由两名或更多工作人员同时进行的。每个治疗阶段，服务使用者平均见到10.24名不同的工作人员。在11%的护理日，只有不认识的工作人员进行家访，在34%的护理日，至少有一名不认识的工作人员进行家访。83%的接触是由相同的三名工作人员进行的，51%的接触是由同一名工作人员进行的。在护理的前七天，服务使用者见到的不同从业者数量与住院时间之间存在显著正相关（r = 0.0007）。
我们的结果表明，IOC治疗初期有大量不同的工作人员与延长的住院时间相关。未来的研究必须阐明这种相关性的确切机制。此外，应该研究IOC团队中的多个专业如何影响住院时间和治疗质量，以及哪些质量指标可能适合确保治疗过程。
