A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care

Abstract

SummaryAim– To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages.Methods– Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs.Results– Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users.Conclusion– It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy

“…Care packages have been defined as the cluster of services, based on carefully constructed components, provided to each patient in different settings by different professionals in a specific time frame (Grigoletti et al, 2010; National Health Service (NHS) Executive, 1997). As described elsewhere (Lora et al, 2007), a previous analysis identified five mutually exclusive packages for individual patients in the course of 1 year:…”

Predictors of Healthcare Service Utilization for Mental Health Reasons

“…The decision to seek help for mental disorders is a complex process that involves personal socio-demographic characteristics, culturally mediated interpretations of symptoms, availability of healthcare services, economic and socio-structural factors, and healthcare service organization [ 22 ]. A number of healthcare service utilization models exist [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ], but most studies of healthcare service utilization for mental health reasons have used the behavioral model developed by Andersen in the 1960s [ 15 , 16 , 17 , 18 , 30 , 31 , 32 ]. This model conceptualized healthcare service utilization as a function of individuals’ predisposing, enabling, and needs characteristics [ 33 , 34 ].…”

Function assertive community treatment (FACT) and psychiatric service use in patients diagnosed with severe mental illness

“…In fact, new Belgian guidelines advise FACT as the standard mode of treatment delivery for SMI patients (SCEM Conference Services, 2011). In Italy, clinical principles comparable to those underlying FACT (outpatient treatment and case management) are guiding treatment delivery (Lora et al 2007, Grigoletti et al 2010). …”