Evaluation of new flexible and integrative psychiatric treatment models in Germany- assessment and preliminary validation of specific program components

Johne, Jakob; Peter, Sebastian von; Schwarz, Julian; Timm, Jürgen; Heinze, Martin; Ignatyev, Yuriy

doi:10.1186/s12888-018-1861-1

Cited by 28 publications

(46 citation statements)

References 39 publications

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“…Im Rahmen einer Vorstudie wurden zunächst elf spezifische Merkmale von MV entwickelt [24]. Diese wurden operationalisiert und zur Bestimmung des Implementierungsgrades in den Studienkliniken herangezogen [14,25]. Ebenfalls auf Grundlage dieser Merkmale wurde ein Fragebogen zur Beurteilung settingübergreifender Versorgung in der Psychiatrie für Patienten entwickelt und validiert ("SEPICC-Scale") [26].…”

Section: Studiendesignunclassified

Analyse von Implementierungsmerkmalen psychiatrischer Modellvorhaben (nach §64b SGB V) in Schleswig-Holstein im Vergleich zum Bundesgebiet

et al. 2019

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Zusammenfassung Ziel Bundesweit gibt es 19 Modellvorhaben nach §64b SGB V (MV), die eine settingübergreifende und flexible psychiatrische Behandlung anbieten. In Schleswig-Holstein (SH) haben sich fünf dieser Modelle gebildet. In einer vergleichenden Analyse wird die Implementierung der MV in SH gegenüber dem Bundesgebiet untersucht. Methodik Standardisierte Befragung von 383 Patienten aus sieben Kliniken, davon drei aus SH, zur Beurteilung der Modellversorgung. Es wurden Struktur-, Leistungs- sowie Daten zum Implementierungsstand von MV in SH und den übrigen Bundesländern analysiert. Ergebnisse MV in SH weisen eine stärkere Ausprägung modellspezifischer Merkmale und einen höheren Implementierungsgrad gegenüber der Vergleichsgruppe auf. Sie befinden sich in öffentlicher Trägerschaft und sind mit allen Krankenkassen verhandelt. Patienten dieser MV werden häufiger ambulant oder aufsuchend behandelt, verfügen über mehr Erfahrung mit spezifischen Aspekten der MV und bewerten diese besser. Schlussfolgerung Die Implementierung der MV in SH kann als besonders erfolgreich angesehen werden. Unter anderem scheint die Unterstützung der Landespolitik eine entscheidende Triebkraft hierfür zu sein.

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Section: Studiendesignunclassified

Analyse von Implementierungsmerkmalen psychiatrischer Modellvorhaben (nach §64b SGB V) in Schleswig-Holstein im Vergleich zum Bundesgebiet

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“…This budget covers all treatment expenses leaving room for the provider to apply an individual treatment strategy. These novel programs will from now on be called FIT programs [FIT = flexible and integrated treatment (26,27)], and hospitals implementing this type of programs will from now on be referred to as FIT hospitals. FIT hospitals are free to tailor specific models of care that suit the regional peculiarities and meet the needs of community members (28).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Initial research results, consisting of data from clinical account databases, cost analysis, patient- and individual staff-related findings are already available for the first FIT projects tested in Germany ( 21 , 23 , 24 ). However, available findings do not suffice to measure the degree of implementation for FIT with due consideration of their character as personal services.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Global Treatment Budget in Psychiatric Departments in Germany—Results and Critical Factors for Success From the Staff Perspective

et al. 2020

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Background Despite evidence from other countries for its effectiveness, flexible and integrative psychiatric treatment (FIT) is not part of the German standard healthcare system. Since 2013, German legislative reform has enabled a test implementation of FIT based on a global treatment budget. Because the budget is not restricted to any particular activity, this legislation opens the possibility of enhancing linkages between inpatient-, outpatient- and day-patient treatment structures. As staff involvement is a relevant component in successful implementation, we aimed in this study to judge the degree of FIT implementation based on staff members’ experiences and evaluations of FIT. Method Within an exploratory study design, we administered a standardized written survey to rate experiences and evaluations of physicians, psychologists, and nurses in the first 13 FIT projects between October 2016 and February 2017. The sample consisted of 352 nurses, 127 physicians, 84 psychologists, and 132 special therapists. We identified critical factors for successful implementation from the staff perspective by logistic regression analysis. Results Staff evaluations of the degree of FIT implementation were generally favorable, although some staff reported no experiences with one or several FIT-specific components. We found considerable differences in the assessments between the occupational groups. The only common factor for successful FIT implementation shared by physicians, psychologists, and nurses was the opportunity to join training programs on the objectives of FIT. Other critical factors for successful implementation were work conditions, the number of nurses/special therapists per physician/psychologist, and project duration. These factors together explained 49% of the variance of physician/psychologist evaluations and 34% for nurse evaluations. Individual staff members’ characteristics were less important than structural- or FIT characteristics as explanatory factors for the degree of FIT implementation. Implications Results point to the importance of new forms of multi-professional cooperation, training programs, improvement of work conditions, and guidance of the implementation process by systematic Change Management for future implementations of FIT. Our exploratory findings require further validation to guide practical improvements in FIT implementation. Longitudinal observations and a multilevel analysis should yield a better understanding of the relevant variables from different organization levels and their possible interactions.

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Evaluation of new flexible and integrative psychiatric treatment models in Germany- assessment and preliminary validation of specific program components

Cited by 28 publications

References 39 publications

Analyse von Implementierungsmerkmalen psychiatrischer Modellvorhaben (nach §64b SGB V) in Schleswig-Holstein im Vergleich zum Bundesgebiet

Analyse von Implementierungsmerkmalen psychiatrischer Modellvorhaben (nach §64b SGB V) in Schleswig-Holstein im Vergleich zum Bundesgebiet

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

Implementation of a Global Treatment Budget in Psychiatric Departments in Germany—Results and Critical Factors for Success From the Staff Perspective

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