Multiperspective and Multimethod Evaluation of Flexible and Integrative Psychiatric Care Models in Germany: Study Protocol of a Prospective, Controlled Multicenter Observational Study (PsychCare).

Bettina Soltmann,Katrin Arnold,Stefanie March,Roman Kliemt,Anne Neumann,Jochen Schmitt,Sebastian Von Peter,Ines Weinhold,Dennis Häckl,Enno Swart,Martin Heinze,Yuriy Ignatyev,Marcel Romanos,Fabian Baum,Andrea Pfennig,Julian Schwarz

doi:10.3389/fpsyt.2021.659773

Abstract

Background: New cross-sectoral mental health care models have been initiated in Germany to overcome the fragmentation of the German health care system. Starting in 2013, flexible and integrative psychiatric care model projects according to §64b SGB V German Social Law (FIT64b) have been implemented. The study “PsychCare” combines quantitative and qualitative primary data with routine health insurance data for the evaluation of these models. Effects, costs and cost-effectiveness from the perspectives of patients, relatives and care providers are compared with standard care. Additionally, quality indicators for a modern, flexible and integrated care are developed. This article describes the rationale, design and methods of the project.Methods: “PsychCare” is built on a multiperspective and multimethod design. A controlled prospective multicenter cohort study is conducted with three data collection points (baseline assessment, follow-up after 9 and 15 months). A total of 18 hospitals (10 FIT64b model and 8 matched control hospitals) have consecutively recruited in- and outpatients with pre-specified common and/or severe psychiatric disorders. Primary endpoints are differences in change of health-related quality of life and treatment satisfaction. Sociodemographic and service receipt data of the primary data collection are linked with routine health insurance data. A cost-effectiveness analysis, a mixed method, participatory process evaluation by means of qualitative surveys and the development of quality indicators are further elements of “PsychCare.”Discussion and Practical Implications: The results based on data from different methodological approaches will provide essential conclusions for the improvement of hospital based mental health care in Germany. This should result in the identification of key FIT64b elements that can be efficiently implemented into standard care in Germany and re-structure the care strongly aligned to patient needs.Clinical Trial Registration: German Clinical Trial Register, identifier DRKS 00022535.

Highlights

BackgroundMental disorders represent the leading causes of disability worldwide and result in a tremendous social and economic burden on individuals and health care systems [1,2,3]
User perspectives have not been methodologically acknowledged for, as previous studies failed to use any participatory approach. This project aims at comparing the effects, costs, costeffectiveness and processes of a Global Treatment Budget (GTB) according to §64b German Social Code Book (SGB) V in the treatment of people with mental disorders compared to standard care
The follow-up procedure could be conducted as planned via postal follow-up survey. This multiperspective and multimethod evaluation study compares the effects, costs and cost-effectiveness and processes of a global treatment budget (GTB) according to the German social law §64b SGB V in the treatment of people with mental disorders compared to standard care in Germany

Summary

Introduction

Mental disorders represent the leading causes of disability worldwide and result in a tremendous social and economic burden on individuals and health care systems [1,2,3]. In Germany, recent epidemiological data indicate that almost 30% of the adult population (18–79 years) met the criteria for at least one mental disorder in the last 12 months and 13% of Germany’s total health care budget is dedicated to mental health care [4, 5]. Broad consensus exists that adequate contemporary mental health care comprises need-based, patient-centered, multiprofessional and cross-sectoral treatment. New cross-sectoral mental health care models have been initiated in Germany to overcome the fragmentation of the German health care system. Starting in 2013, flexible and integrative psychiatric care model projects according to §64b SGB V German Social Law (FIT64b) have been implemented. This article describes the rationale, design and methods of the project

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