Evaluation of Home Treatment for Acute Psychiatric Care

Study Overview
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Brief Summary
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The study's goal is to evaluate whether home treatment is an effective and efficient alternative to inpatient care for people with acute mental illness. Patients who meet the study's inclusion criteria are randomly assigned to either the condition home treatment or inpatient care (treatment-as-usual), during one year. Following two years, the two treatment modalities will be analyzed in terms of inpatient days, cost effectiveness, rehospitalization rate, severity of symptoms and sociodemographics.

Detailed Description
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The study's goal is to evaluate whether home treatment is an effective and efficient alternative to inpatient care for people with acute mental illness. Therefore, psychiatric patients in need of hospitalization who meet the study's inclusion criteria are randomly assigned to either the condition home treatment or inpatient care (treatment-as-usual) during one year. Home treatment patients are visited by a mobile and multiprofessional care team at their homes. Additionally, patients without a health insurance for home treatment and patients who are directly assigned to home treatment are included in separate study groups. Following two years, it will be checked whether home treatment leads to a reduction of inpatient days as a primary outcome. Further outcomes such as cost effectiveness, rehospitalization rate, severity of symptoms and sociodemographics will be also analyzed.

Official Title
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Evaluation of Home Treatment for Acute Psychiatric Care of the Psychiatric University Hospital Zurich (Switzerland)

Conditions
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Mental Disorder

Intervention / Treatment
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* Other: Home Treatment
* Other: Treatment-as-usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Need for acute psychiatric inpatient care Residence in Zurich city Health insurance for Home Treatment Exclusion Criteria: none

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Home Treatment<br>Patients with acute mental illness are treated at their houses by a mobile and multiprofessional care team instead of being treated as inpatients if their medical condition permits. | Other: Home Treatment<br>* Patients with acute mental illness in need of inpatient care are treated at their houses by a mobile and multiprofessional care team if their health condition permits.<br>|
| Active Comparator: Treatment-as-usual<br>Patients with acute mental illness are treated as inpatients in a psychiatric clinic. | Other: Treatment-as-usual<br>* Patients with acute mental illness in need of inpatient care are treated in a psychiatric clinic.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inpatient days | Number of inpatient days per patient | 2 years follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total days in treatment | Total days in Treatment per patient = inpatient and home treatment | 2 years follow-up | 
| Treatment costs | Calculated direct treatment costs | 2 years follow-up | 
| Rehospitalization rate | Number of rehospitalizations per patient and duration until rehospitalization | 2 years follow-up | 
| Adverse events | e.g. suicide or attempted suicide | 2 years follow-up | 
| Global Assessment of Functioning Scale (GAF) | Scale measures social, occupational and psychological functioning and ranges from 0 to 100 (higher values mean better outcome). | 2 years follow-up | 
| Health of the Nation Outcome Scale (HoNOS) | Scale measures the severity of symptoms and ranges from 0 to 48 (higher values mean worse outcome). | 2 years follow-up | 
| Clinical Global Impression Scale (CGI) | Scale measures the severity of symptoms, global improvement and therapeutic response and ranges from 0 to 7 (higher values mean worse outcome). | 2 years follow-up | 
| Patients' satisfaction | Patients' satisfaction assessed by the official questionnaire of the national association of the quality development in hospitals (ANQ) | 2 years follow-up |