title: Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment.
abstract: BACKGROUND
  Mental healthcare organisation can either pursue specialisation, that is, distinct clinicians and teams for inpatient and outpatient care or personal continuity of care, that is, the same primary clinician for a patient across the two settings. Little systematic research has compared these approaches. Existing studies subject have serious methodological shortcomings. Yet, costly reorganisations of services have been carried out in different European countries, inconsistently aiming to achieve specialisation or personal continuity of care. More reliable evidence is required on whether specialisation or continuity of care is more effective and cost-effective, and whether this varies for different patient groups and contexts.
  
  
  METHODS
  In a natural experiment, we aim to recruit at least 6000 patients consecutively admitted to inpatient psychiatric care in Belgium, Germany, Italy, Poland, and the UK. In each country, care approaches supporting specialisation and personal continuity coexist. Patients will be followed up at 1 year to compare outcomes, costs and experiences. Inclusion criteria are: 18 years of age or older; clinical diagnosis of psychosis, affective disorder or anxiety/somatisation disorder; sufficient command of the language of the host country; absence of cognitive deterioration and/or organic brain disorders; and capacity to provide informed consent.
  
  
  BACKGROUND
  Ethical approval was obtained in all countries: (1) England: NRES Committee North East-Newcastle & North Tyneside (ref: 14/NE/1017); (2) Belgium: Comité d'Ethique hospitalo-facultaire des Cliniques St-Luc; (3) Germany: Ethical Board, Technische Universität Dresden; (4) Italy: Comitati Etici per la sperimentazione clinica (CESC) delle provincie di Verona, Rovigo, Vicenza, Treviso, Padova; (5) Poland: Komisja Bioetyczna przy Instytucie Psychiatrii i Neurologii w Warszawie. We will disseminate the findings through scientific publications and a study-specific website. At the end of the study, we will develop recommendations for policy decision-making, and organise national and international workshops with stakeholders.
  
  
  BACKGROUND
  ISRCTN registry: ISRCTN40256812.
authors.affiliation: Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.
authors.forename: Domenico
authors.initials: D
authors.lastname: Giacco
authors.affiliation: Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.
authors.forename: Victoria Jane
authors.initials: VJ
authors.lastname: Bird
authors.affiliation: Health Service and Population Research Department, Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.affiliation: Institute of Health and Society IRSS, Université catholique de Louvain, Bruxelles, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lorant
authors.affiliation: Institute of Health and Society IRSS, Université catholique de Louvain, Bruxelles, Belgium.
authors.forename: Pablo
authors.initials: P
authors.lastname: Nicaise
authors.affiliation: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pfennig
authors.affiliation: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Ruggeri
authors.affiliation: Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lasalvia
authors.affiliation: Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Moskalewicz
authors.affiliation: Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Welbel
authors.affiliation: Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000553:Ambulatory Care; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005060:Europe; D006760:Hospitalization; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D012107:Research Design; D013038:Specialization
keywords: MENTAL HEALTH; PUBLIC HEALTH