Effectiveness of Global Treatment Budgets for Patients With Mental Disorders—Claims Data Based Meta-Analysis of 13 Controlled Studies From Germany

Abstract

Background: Individuals with mental disorders need continuous and efficient collaboration between different sectors of care. In 2012, a new law in Germany enabled the implementation of novel budgets in psychiatry (flexible and integrated treatment = FIT). Hospitals implementing FIT programs have been evaluated in controlled cohort studies. We present first results based on a meta-analysis from 13 FIT hospitals.Methods/Design: We undertook a series of claims-data-based controlled cohort studies. Data from over 70 statutory health insurance (SHI) funds in Germany were analyzed. All patients insured by any of the participating SHI funds and treated in one of the FIT hospitals for any of 16 predefined mental disorders were compared with matched control patients from routine care. The patient collective was subdivided into hospital-new and hospital-known patients. Analyses included utilization of inpatient care, day care, outpatient PIA (psychiatrische Institutsambulanz) care, outpatient care with established practitioners, and durations of sick leave. Individual treatment effects of the 13 FIT hospitals were pooled in a random-effects meta-analysis. Meta-regression analysis was used to explore potential reasons for heterogeneity in model effectiveness. Results:The meta-analysis revealed a significant reduction by over 5 days of inpatient care in hospital-new patients in FIT hospitals compared to control hospitals. This effect was stronger among FIT hospitals with a preexisting FIT-like environment. There was no overall significant effect regarding sick leave between the two groups. Further meta-regression for hospital-new patients revealed a significantly reduced duration of sick leave by almost 13 days for patients in FIT hospitals with a preexisting FIT-like contract compared to FIT hospitals without such a contract. Conclusions:This study suggests positive effects of FIT programs for patients with mental disorders pointing toward a shorter duration of inpatient treatment. Furthermore, contracts already existent prior to initialization of FIT programs appear to have facilitated the transition into the new treatment environment. For FIT hospitals without such Baum et al. Effectiveness of Global Treatment Budgetscontracts, supposedly there is a certain implementation phase for effects to be apparent. The results should still be interpreted with caution as this manuscript only covers the first year of the 5 year evaluation period in 13 of 18 FIT hospitals.

Changes in German Mental Health Care by Implementing a Global Treatment Budget—A Mixed-Method Process Evaluation Study

“…The first outcome evaluations of these models have already shown positive effects, such as a reduction in inpatient length of stay, as well as an increase in the number of patients treated in outpatient and outreach settings (10)(11)(12)(13)(14). Most importantly, clinical outcomes (e.g., HoNOS, CGI, GAF) improved and overall psychiatric care costs were kept stable or even decreased (10,(15)(16)(17)(18).…”

Implementierung eines globalen Behandlungsbudgets in der Psychiatrie – Welche Anreize, Voraussetzungen und Herausforderungen gibt es?

“…Erste Ergebnisse der gesetzlich verpflichtenden Evaluation (nach § 65 SGB V; "EVA64"-Studie) weisen auf eine Reduktion der stationären Behandlungstage in den MV hin [5][6][7]. Durch in einzelnen Modellregionen durchgeführte Begleitforschungsprojekte konnte außerdem eine Reduktion von Betten, voll-und teilstationärer Belegungstage und der kumulativen Verweildauer belegt werden.…”

Verringerung vollstationärer Behandlungstage in psychiatrischen Kliniken mit Modellvorhaben zur patientenzentrierten Versorgung mit globalem Budget (§ 64b SGB V)

“…Daher konnten weitere mögliche Störvariablen wie Komorbiditäten, welche nicht explizit über das Matching aufgegriffen wurden, nicht berücksichtigt werden. Weitere Evaluationen mit inferenzstatistischen Auswertungen und Berücksichtigung weiterer Störvariablen [28] folgen. Weiterhin sind patientenzentrierte Aussagen wie Symptomschwere, Lebensqualität und Behandlungszufriedenheit für eine umfassende Aussage über die Effektivität der Modellvorhaben unerlässlich.…”