Hospital utilization outcome of an assertive outreach model for schizophrenic patients – results of a quasi-experimental study

Abstract

We assessed whether an Assertive Outreach (AO) program for patients with schizophrenia implemented in German routine care in rural areas reduces psychiatric hospital admissions and/or psychiatric hospital days. We conducted a quasi-experimental controlled study with 5 assessments in 12 months. Data collection included health care utilization (Client Sociodemographic and Service Receipt Inventory), and clinical parameters. The assessments took place in the practices of the psychiatrists. Admission incidence rates were calculated. For bivariate group comparison, we used U-tests, T-tests and Chi2-Tests, multivariate analysis was conducted using zero-inflated regression models. For hospital outcomes, data of 295 patients was analysed. No statistically significant differences between AO and TAU patients in terms of hospital admissions or hospital days were found. Overall hospital utilization was low (8%). Advantages of AO over TAU referring to hospital utilization were not found. However, a spill-over effect might have reduced hospital utilization in both groups. Further research should differentiate patient subgroups. These two appear to be key factors to explain effects or absence of effects and to draw conclusions for the mental health care delivery.