title: A 10-year service evaluation of an assertive community treatment team: trends in hospital bed use.
abstract: BACKGROUND
  Studies of assertive community treatment (ACT) have shown various benefits, including reduced hospital bed use. In the UK, this finding was not replicated by randomised controlled trials (RCTs), which lacked fidelity to the model. Conversely, observational studies, while limited by their inherent weakness in implying causality, have shown lower bed use. Against this background many ACT teams are being disestablished in the UK.
  
  
  OBJECTIVE
  To observe the long-term effect of ACT on bed use, incorporating methods of analysis which mitigate against some weaknesses of observational design.
  
  
  METHODS
  Bed use was compared for equal periods of time either side of starting support from an ACT team.
  
  
  RESULTS
  Ninety-three people were followed for up to 10.5 years after starting ACT. Hospital bed use was compared for each person, showing a reduction from a mean of 72 d per year prior to ACT to 44 d per year during ACT (p = 0.0018).
  
  
  CONCLUSIONS
  The results demonstrate that ACT is associated with reduced bed use in the UK and that it is possible to use an observational design with enhanced analysis techniques to increase evidence for causality. These techniques may have value in other service evaluations.
authors.affiliation: Coventry and Warwickshire NHS Partnership Trust, St Michaels Hospital , Warwick , UK.
authors.forename: Loopinder
authors.initials: L
authors.lastname: Sood
authors.forename: Andy
authors.initials: A
authors.lastname: Owen
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006113:United Kingdom
keywords: Assertive; community; outreach; schizophrenia; treatment