Evaluation of a flexible and integrative psychiatric care model in a department of child and adolescent psychiatry in Tübingen, Germany: study protocol (EVA_TIBAS)

Anne Neumann, Helene Hense, Fabian Baum, Roman Kliemt, Martin Seifert, Lorenz Harst, Denise Kubat, Birgit Maicher, Christopher Schrey, Jochen Schmitt, Andrea Pfennig, Ines Weinhold, Enno Swart, Bettina Soltmann, Anne Neumann, Helene Hense, Fabian Baum, Roman Kliemt, Martin Seifert, Lorenz Harst, Denise Kubat, Birgit Maicher, Christopher Schrey, Jochen Schmitt, Andrea Pfennig, Ines Weinhold, Enno Swart, Bettina Soltmann

Abstract

Background: Model projects for flexible and integrated treatment (FIT) in Germany aim at advancing the quality of care for people with mental disorders. A new FIT model project was established in 2017 at the Department of child and adolescent psychiatry (KJP) of the University Hospital Tübingen (Universitätsklinikum Tübingen, UKT). The study design of EVA_TIBAS presented here describes the evaluation of the FIT model project at the KJP of the UKT. This evaluation aims at quantifying the anticipated FIT model project changes, which are to improve patients' cross-sectoral care at the same maximum cost as standard care.

Methods: EVA_TIBAS is a controlled cohort study using a mix of quantitative and qualitative methods. The FIT evaluation consists of three modules. In Module A, anonymized claims data of a statutory health insurance fund will be used to compare outcomes (duration of inpatient and day care psychiatric treatment, inpatient and day care psychiatric length of stay, outpatient psychiatric treatment in hospital, inpatient hospital readmission, emergency admission rate, direct medical costs) of patients treated in the model hospital with patients treated in structurally comparable control hospitals (estimated sample size = ca. 600 patients). In Module B, patient-reported outcomes (health related quality of life, symptom burden, return to psychosocial relationships (e.g. school, friends, hobbies), treatment satisfaction, societal costs) will be assessed quantitatively using validated questionnaires for the model and two control hospitals (estimated sample size = ca. 300 patients). A subsequent health economic evaluation will be based on cost-effectiveness analyses from both the insurance fund's and the societal perspective. In Module C, about 30 semi-structured interviews will examine the quality of offer, effects and benefits of the service offered by the social service of the AOK Baden-Württemberg (for stabilizing the overall situation of care in the family) in the model hospital. A focus group discussion will address the quality of cooperation between employees of the university hospital and the social services.

Discussion: The results of this evaluation will be used to inform policy makers whether this FIT model project or aspects of it should be implemented into standard care.

Trial registration: This study was registered at ClinicalTrials.gov PRS (ID: NCT04727359 , date: 27 January 2021).

Keywords: Cohort study; Department of child and adolescent psychiatry; Effectiveness and cost-effectiveness; Evaluation; FIT; Flexible and integrated treatment; Health services research; Inpatient and outpatient treatment; Mental health care; Qualitative and quantitative.

Conflict of interest statement

The authors have no competing interests to declare/Not Applicable.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Study data flow chart
Fig. 2
Fig. 2
Outcomes and Hypotheses

References

    1. Mauz E, Lange M, Houben R, Hoffmann R, Allen J, Gößwald A, et al. Cohort profile: KiGGs cohorot longitudinal study on the health of children, adolescents and young adults in Germany. Int J Epidemiol. 2020;49(2):375-k. doi: 10.1093/ije/dyz231.
    1. Klipker K, Baumgarten F, Göbel K, Lampert T, Hölling H. Psychische Auffälligkeiten bei Kindern und Jugendlichen in Deutschland - Querschnittergebnisse aus KiGGS Welle 2 und Trends. J Health Monit. 2018;3:37–45.
    1. Harsch D, Hoffmann U. Vielfältige Versorgungsangebote. Deutsches Ärzteblatt. 2018;6:267–269.
    1. Ravens-Sieberer U, Wille N, Bettge S, Erhart M. Mental health of children and adolescents in Germany. Results from the BELLA study within the German health interview and examination survey for children and Adolescnets (KiGGS) Bundesgesundheitsblatt. 2007;50(5-6):871–878. doi: 10.1007/s00103-007-0250-6.
    1. Plener PL, Straub J, Fegert M, Keller F. Treatment of mental diseases in children in German hospitals: analysis of frequencies in the years 2003 to 2012. Nervenheilkunde. 2015;34:18–23. doi: 10.1055/s-0038-1627551.
    1. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JS, Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27. doi: 10.1017/S0033291714000129.
    1. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359–364. doi: 10.1097/YCO.0b013e32816ebc8c.
    1. Jones PB. Adult mental health disorders and their age at onset. Br J Psychiatry Suppl. 2013;54:s5–10. doi: 10.1192/bjp.bp.112.119164.
    1. Fegert JM. Versorgung psychisch kranker Kinder und Jugendlicher in Deutschland - Bestandsaufnahme und Bedarfsanalyse. Berlin: APK-Jahrestagung; 2018.
    1. Fegert JM, Kölch M, Krüger U. Sachbericht: Versorgung psychische kranker Kinder und Jugendliche in Deutschland - Bestandsaufnahme und Bedarfsanalyse. 2017.
    1. Kliemt R, Häckl D. Anreize und Weiterentwicklungsperspektiven der Vergütung von Psychiatrie und Psychosomatik unter der Berücksichtigung von Modellprojekten. In: Klauber J, Geraedts M, Friedrich J, Wasem J, Beivers A, editors. Krankenhaus-Report 2020 - Finanzierung und Vergütung am Scheideweg. Berlin: Springer; 2020. pp. 263–280.
    1. Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. Gutachten 2018: Bedarfsgerechte Steuerung der Gesundheitsversorgung. Kapitel 16: Koordinierte Versorgung von Menschen mit psychischen Erkrankungen. . zuletzt aufgerufen am 15.11.2019.
    1. Federal Ministry of Justic and Consumer Protection . § 64b SGB V: Modellvorhaben zur Versorgung psychisch kranker Menschen [Modell projects for the care of mentally ill people] 2012.
    1. Federal Ministry of Justic and Consumer Protection . §140a SGB V: Besondere Versorgung [Special Care] 2015.
    1. Federal Ministry of Justic and Consumer Protection . § 65 SGB V: Auswertung der Modellvorhaben [Evaluation of model projects] 2012.
    1. Baum F, Schoffer O, Neumann A, Seifert M, Kliemt R, March S, et al. Effectiveness of Global Treatment Budgets for Patients With Mental Disorders—Claims Data Based Meta-Analysis of 13 Controlled Studies From Germany. Front. Psychiatry, 24 March 2020. 10.3389/fpsyt.2020.00131.
    1. Gemeinsamer Bundesausschuss . Referenzdatenbank - Qualitätsbericht der Krankenhäuser. 2018.
    1. Bundesinstitut für Bau- S-uRIfRoB, Urban Affairs and Spatial Development (BBSR)] INKAR - Indikatoren und Karten zur Raum- und Stadtentwicklung Bonn. 2016.
    1. Kassenärtzliche Vereinigung Baden-Württemberg . Landesausschuss Ärzte/Krankenkassen. 2021.
    1. Petzold T, Neumann A, Seifert M, Kuster D, Pfennig A, Weiss J, et al. Identification of control hospitals for the implementation of the Nationwide and standardized evaluation of model projects according to section sign 64b SGB V: analysis of data from structured quality reports. Gesundheitswesen. 2019;81(1):63–71. doi: 10.1055/s-0042-116436.
    1. Neumann A, Swart E, Häckl D, Kliemt R, March S, Kuster D, et al. The influence of cross-sectoral treatment models on patients with mental disorders in Germany: study protocol of a nationwide long-term evaluation study (EVA64) Bmc Psychiatry. 2018;18(1):139. doi: 10.1186/s12888-018-1721-z.
    1. Soltmann B, Neumann A, March S, Weinhold I, Hackl D, Kliemt R, et al. Multiperspective and multimethod evaluation of flexible and integrative psychiatric care models in Germany: study protocol of a prospective, controlled multicenter observational study (PsychCare) Front Psychiatry. 2021;12:659773. doi: 10.3389/fpsyt.2021.659773.
    1. Neumann A, Baum F, Seifert M, Schoffer O, Kliemt R, March S, Häckl D, Swart E, Pfennig A, Schmitt J. Reduction of days in inpatient Care in Psychiatric Hospitals with flexible and integrated treatment for patient-centered care with a global budget - results with three-year follow-up from the evaluation study EVA64. Psychiatr Prax. 2021;48(3):127–134. doi: 10.1055/a-1274-3731.
    1. Studiengruppe EVA64. Evaluation von Modellvorhaben in der Psychiatrie nach § 64b SGB V - Berichte: 2019 [cited 2019 18.10.2019]. Available from: .
    1. Ravens-Sieberer U, Auquier P, Erhart M, Gosch A, Rajmil L, Bruil J, Power M, Duer W, Cloetta B, Czemy L, Mazur J, Czimbalmos A, Tountas Y, Hagquist C, Kilroe J, the European KIDSCREEN Group The KIDSCREEN-27 quality of life measure for children and adolescents: psychometric results from a cross-cultural survey in 13 European countries. QualLife Res. 2007;16(8):1347–1356. doi: 10.1007/s11136-007-9240-2.
    1. Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry Allied Disciplines. 1997;38(5):581–586. doi: 10.1111/j.1469-7610.1997.tb01545.x.
    1. Mattejat F, Remschmidt H. Assessing the quality of life of children and adolescents with psychiatric disorders--a review. Z Kinder Jugendpsychiatr Psychother. 1998;26(3):183–196.
    1. Roick C, Kilian R, Matschinger H. Die deutsche Version des Client Sociodemographic and Service Receipt Inventory – Ein Instrument zur Erfassung osychiatrischer Versorgungskosten. Psychiatr Prax. 2001;28(Suppl 2):84–90. doi: 10.1055/s-2001-17790.
    1. Grupp H, Konig HH, Riedel-Heller S, Konnopka A. FIMPsy - questionnaire for the assessment of medical and non medical resource utilisation in mental disorders: development and application. Psychiatr Prax. 2018;45(2):87–94. doi: 10.1055/s-0042-118033.
    1. Schmid R, Schielein T, Spiessl H, Bauer M. Multi Centre study of the work crisis “young scientist” of the DGBS e. V. Strain perception of dependent bipolar patients. Psychiatr Prax. 2008;35(7):364–365. doi: 10.1055/s-0028-1100472.
    1. Kusch M, Hudde-Korte K, Knauer B. LARES-Geschwisterkinder. Validierung eines psychosozialen Screeninginstruments für Geschwister von Kindern mit besonderem Versorgungsbedarf. 2011.
    1. Austin PC. The relative ability of different propensity score methods to balance measured covariates between treated and untreated subjects in observational studies. Med Decis Mak. 2009;29(6):661–677. doi: 10.1177/0272989X09341755.
    1. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41–55. doi: 10.1093/biomet/70.1.41.
    1. Kullback S. Information theory and statistics. New York: Wiley; 1959.
    1. Hainmueller J. Entropy balancing for causal effects: a multivariate reweighting method to produce balanced samples in observational studies. Polit Anal. 2012;20(1):25–46. doi: 10.1093/pan/mpr025.
    1. Helfferich C. Die Qualität qualitativer Daten. Manual für die Durchführung qualitativer interviews. 4. Wiesbaden: VS Verlag für Sozialwissenschaften; 2011.
    1. Bronstein LR. A model for interdisciplinary collaboration. Soc Work. 2003;48(3):297–306. doi: 10.1093/sw/48.3.297.
    1. Gabrielova J, Veleminsky M., Sr Interdisciplinary collaboration between medical and non-medical professions in health and social care. Neuro Endocrinol Lett. 2014;35(Suppl 1):59–66.
    1. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–1907. doi: 10.1007/s11135-017-0574-8.
    1. Mayring P. Qualitative Inhaltsanalyse: Grundlagen und Techniken Weinheim: Beltz. 2010.
    1. Creamer EG. An Introduction to Fully Integrated Mixed Methods Research. Los Angeles | London New Delhi | Singapore | Washington DC | Melbourne: SAGE Publications; 2018.
    1. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134–2156. doi: 10.1111/1475-6773.12117.
    1. German Society for Epidemiology (DGEpi) Good Epidemiological Practice (GEP) 2004.
    1. Swart E, Gothe H, Geyer S, Jaunzeme J, Maier B, Grobe T, Ihle P, German Society for Social Medicine and Prevention., German Society for Epidemiology Gute praxis Sekundärdatenanalyse (GPS): Leitlinien und Empfehlungen [Goode practice secondary data analysis: guidelines and recommendations] Gesundheitswesen. 2015;77(2):120–126. doi: 10.1055/s-0034-1396815.
    1. Swart E, Bitzer E, Gothe H, Harling M, Hoffmann F, Horenkamp-Sonntag D, et al. STandardisierte BerichtsROutine für SekundärdatenAnalysen (STROSA) – ein konsentierter Berichtsstandard fürDeutschland, Version 2. Gesundheitswesen 2016;78(S 01): e145–60.10.1055/s-0042-108647.
    1. von der Schulenburg G, Greiner W, Jost F, Klusen N, Kubin M, Leidl R, et al. Deutsche Empfehlung zur gesundheitsökonomischen evaluation - dritte und aktualisierte Fassung des Hannoveraner Konsens [German recommendations on health economic evaluation - third and updated version of the Hannover consensus] Gesudh ökon Qual Manag. 2007;12(5):285–293. doi: 10.1055/s-2007-963505.

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