title: 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 Chi(2)-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.
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Büchtemann
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf & Schoen Clinic Hamburg Eilbek, Hamburg, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Kästner
authors.affiliation: Psychiatric University Hospital, University of Zurich, Switzerland.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Warnke
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany.
authors.forename: Jeanett
authors.initials: J
authors.lastname: Radisch
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany; Department of Social Work, University of Applied Sciences (HAW) Hamburg, Germany. Electronic address: johanna.baumgardt@haw-hamburg.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Baumgardt
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany.
authors.forename: Steffi
authors.initials: S
authors.lastname: Giersberg
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Kleine-Budde
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Moock
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany; Psychiatric University Hospital, University of Zurich, Switzerland.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Kawohl
authors.affiliation: Innovation Incubator, Leuphana University Luneburg, Germany; Psychiatric University Hospital, University of Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil.
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003159:Community-Institutional Relations; D005260:Female; D005858:Germany; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065228:Non-Randomized Controlled Trials as Topic; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D019035:Rural Health Services / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000628:therapy*
keywords: Germany; Integrated care; Schizophrenia