title: Structures and processes necessary for providing effective home treatment to severely mentally ill persons: a naturalistic study.
abstract: Home treatment for severely mentally ill persons is becoming increasingly popular. This research aims to identify structures and processes in home treatment that impact on patient-related outcomes.
  
  
  
  We analysed 17 networks that provide home treatment to severely mentally ill persons using a naturalistic approach. The networks were similar with regard to central components of home treatment such as case management, 24 h crisis hotline and home visits, but differed in all other aspects such as the multidisciplinary teams, time spent with patients, etc. To determine treatment outcome, patients' psychosocial functioning was measured using the Health of the Nation Outcome Scales (HoNOS). Structures and processes were assessed using claims data and questionnaires answered by the different networks. Primary outcome was highlighted by the change in HoNOS scores from the start of home treatment compared with 6 months later. We sought to explain this outcome through patient and network characteristics using regression analysis. Data on 3,567 patients was available.
  
  
  
  On average, psychosocial functioning improved by 0.84 across networks between t0 and t1. There were more similarities than differences between the networks with regard to the structures and processes that we tested. A univariate regression analysis found staff's prior experience in mental health care and the effort that they invested in their work correlated positively with patient outcome. This needs to be interpreted under considering that univariate analysis does not show causal relationship. A high case load per case manager, increased and longer patient contact and more family intervention were correlated with worse patient outcome, probably indicating that sicker patients receive more care and intervention.
  
  
  
  Home treatment networks succeed in delivering care tailored to the needs of patients. In order to improve the quality of care in home treatment, this study suggests employing experienced staff who is ready to invest more effort in their patients. Further research needs to consider a longer follow-up time.
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmuehlenweg 8-10, 37073, Goettingen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Bauer
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmuehlenweg 8-10, 37073, Goettingen, Germany. Katja.Kleine-Budde@aqua-institut.de.
authors.forename: K
authors.initials: K
authors.lastname: Kleine-Budde
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmuehlenweg 8-10, 37073, Goettingen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Stegbauer
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmuehlenweg 8-10, 37073, Goettingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kaufmann-Kolle
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany.|Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Ratzeburger Allee 160 / Haus 50, 23538, Luebeck, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Goetz
authors.affiliation: Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG), Bramfelder Str. 140, 22305, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Bestmann
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmuehlenweg 8-10, 37073, Goettingen, Germany.|Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmuehlenweg 8-10, 37073, Goettingen, Germany.|Department Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Bramesfeld
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Claims data; Health services research; Integrated care; Mental health services; Quality assessment; Quality of care