Versorgungsindikatoren in der Psychiatrie und Psychosomatik (VIPP) – Ein Datenbank-Projekt

Mental health indicators for children and adolescents in OECD countries: a scoping review

Background

This scoping review is a further step to build up the Mental Health Surveillance System for Germany. It summarizes and analyzes indicators used or described in Organization for Economic Co-operation and Development (OECD) countries for public mental health monitoring in children and adolescents aged 0-18 years.

Methods

We searched PubMed-MEDLINE, PsycINFO, Cochrane Databases, and Google Scholar from 2000 to September 2022. The search used five general keyword categories: 1) "indicators/monitoring/surveillance" at the population level, 2) "mental/psychological," 3) "health/disorders," 4) "children and adolescents," and 5) 38 OECD countries. The search was complemented with an extensive grey literature search, including OECD public health institutions and an internet search using Google. A predefined set of inclusion and exclusion criteria was applied.

Results

Over 15,500 articles and documents were screened (scientific search N = 10,539, grey literature search more than 5,000). More than 700 articles and documents have been full-text assessed, with 382 being ultimately included. Out of 7,477 indicators extracted, an initial set of 6,426 indicators met our inclusion criteria for indicators. After consolidating duplicates and similar content, this initial set was categorized into 19 topics, resulting in a final set of 210 different indicators. The analysis highlighted an increasing interest in the topic since 2008, but indicators for the younger age, particularly those aged 0 to 2 years, were less readily available.

Conclusion

Our research provides a comprehensive understanding of the current state of mental health indicators for children and adolescents, identifying both (1) indicators of public mental health noted in a previous scoping review on adults and (2) new indicators specific to this age group. These findings contribute to the development of effective public health surveillance strategies for children and adolescents and inform future research in this field.

[Day care/inpatient psychiatric treatment of minors and adults with hyperkinetic disorder in German psychiatric hospitals : Basic conditions, diagnoses and comorbidities]

BACKGROUND

Hyperkinetic disorders (HKD, ICD-10 F90.‑) have increasingly been the focus of research literature in recent years. Empirical studies analyzing the care situation in psychiatric clinics are so far primarily available for a few health insurances. This study analyzed a German sample from 2015 consisting of inpatient as well as day care psychiatric treatment cases from all statutory health insurances focusing on the care situation and differentiating between minor vs. adult patients with the main diagnosis HKD.

MATERIAL AND METHODS

The study was based on the treatment relevant indicators in psychiatry and psychosomatics (VIPP) database, which contains data according to §21 of the Hospital Remuneration Act (KHEntgG). A total of 896 treatment cases with the diagnosis of HKD from the year 2015, based on anonymized routine records from 41 psychiatric clinics, were analyzed.

RESULTS

The basic conditions for inpatient/day care psychiatric treatment significantly differed between minor vs. adult patients. Minors travelled greater distances to the treatment site, received more therapy units and stayed longer in the psychiatric clinic than adults. Significant differences were also found between the subgroups concerning the main diagnoses according to ICD-10 coding as well as comorbid mental disorders.

CONCLUSION

Due to greater distances from their residence to a psychiatric hospital for minors, extension of capacities with a focus on child and youth psychiatry seems to be a reasonable conclusion. Simultaneously, the intensity of treatment seems to be lower for adult patients, despite a greatly increased number of secondary diagnoses and thus anticipated psychological stress. Transition difficulties from child and youth psychiatry to adult psychiatry may be a possible explanation for this discrepancy.

Routine Data Indicators of Treatment for Dementia and Old-Age Depression

Abstract. Complications in the course of dementia are one of the leading reasons for treatment in German psychiatric hospitals. One way to assess treatment quality with a moderate effort is to analyze existing routine data. A large routine dataset exists for psychiatric hospitals in Germany. This work reports on the indicators of inpatient treatment of patients with dementia and compares them to those found with old-age depression. Among other results it was shown that no specific dementia diagnosis was defined in more than 15% of all cases, and that the readmission rate within 30 days was more than 25%. Depressed people, on the other hand, showed lower readmission rates: They got more specific diagnoses and more therapeutic contacts. In conclusion, several aspects of diagnosis and treatment demand improvement among patients with dementia.

[Guideline-adherent inpatient psychiatric psychotherapeutic treatment of behavioral and psychological symptoms of dementia : Normative definition of personnel requirements]

BACKGROUND

Dementia is of increasing medical and societal relevance. Hospitalization of dementia patients is mostly due to behavioral and psychological symptoms of dementia (BPSD). There is a need for sufficient qualified personnel in hospitals in order to be able to effectively treat these symptoms.

OBJECTIVES

This study aims at identifying the personnel requirements for guideline-conform, evidence-based inpatient treatment concepts for patients with BPSD and to compare these with the resources defined by the German psychiatric personnel regulations (Psych-PV). Furthermore, it was the aim to identify how often patients with dementia received non-pharmacological therapy during inpatient treatment.

METHODS

Based on the current scientific evidence for treatment of BPSD, a schedule for a multimodal non-pharmacological treatment was defined and based on this the corresponding personnel requirements were calculated. Using the treatment indicators in psychiatry and psychosomatics (VIPP) database as a reference, it was calculated on what proportion of treatment days patients were classified into G1 according to the German Psych-PV and at least once received more than two treatment units per week.

RESULTS

For the implementation of a guideline-oriented and evidence-based treatment plan, a higher need for personnel resources than that provided by the Psych-PV was detected in all areas. Currently patients with dementia who received at least more than two treatment units per week during inpatient hospitalization, were classified into G1 according to German Psych-PV on 17.9 % of treatment days.

CONCLUSION

Despite evidence for the efficacy of non-pharmacological treatment measures on BPSD, these forms of treatment cannot be sufficiently provided under the current conditions. The realization of a new quality controlled therapeutic concept is necessary to enable optimized treatment of patients with BPSD.

Evidence for Distinguishable Treatment Costs among Paranoid Schizophrenia and Schizoaffective Disorder

BACKGROUND

Schizophrenia spectrum disorders result in enormous individual suffering and financial burden on patients and on society. In Germany, there are about 1,000,000 individuals suffering from schizophrenia (SZ) or schizoaffective disorder (SAD), a combination of psychotic and affective symptoms. Given the heterogeneous nature of these syndromes, one may assume that there is a difference in treatment costs among patients with paranoid SZ and SAD. However, the current the national system of cost accounting in psychiatry and psychosomatics in Germany assesses all schizophrenia spectrum disorders within one category.

METHODS

The study comprised a retrospective audit of data from 118 patients diagnosed with paranoid SZ (F20.0) and 71 patients with SAD (F25). We used the mean total costs as well as partial cost, i.e., mean costs for medication products, mean personal costs and mean infrastructure costs from each patient for the statistical analysis. We tested for differences in the four variables between SZ and SAD patients using ANCOVA and confirmed the results with bootstrapping.

RESULTS

SAD patients had a longer duration of stay than patients with SZ (p = .02). Mean total costs were significantly higher for SAD patients (p = .023). Further, we found a significant difference in mean personnel costs (p = .02) between patients with SZ and SAD. However, we found no significant differences in mean pharmaceutical costs (p = .12) but a marginal difference of mean infrastructure costs (p = .05) between SZ and SAD. We found neither a common decrease of costs over time nor a differential decrease in SZ and SAD.

CONCLUSION

We found evidence for a difference of case related costs of inpatient treatments for paranoid SZ and SAD. The differences in mean total costs seem to be primarily related to the mean personnel costs in patients with paranoid SZ and SAD rather than mean pharmaceutical costs, possibly due to higher personnel effort and infrastructure.

Routine outcome measures in Germany

The German healthcare system offers comprehensive coverage for people with mental illness including inpatient, day hospital and outpatient services. These services are primarily financed through the statutory health and pension insurances. According to legal regulations, providers are required to base their services on current scientific evidence and to continuously assure the quality of their services. This paper gives an overview of recent initiatives to develop, evaluate and disseminate routine outcome measurement (ROM) in service settings in Germany. A large number of projects have shown outcome monitoring to be feasible, and that feedback of outcome may enhance routine care through an improved allocation of treatment resources. However, none of these initiatives have been integrated into routine care on a nationwide or trans-sectoral level, and their sustainability has been limited. This is due to various barriers in a fragmented mental health service system and to the lack of coordinated national or state-level service planning. The time is ripe for a concerted effort including policy-makers to pick up on these initiatives and move them towards wide-spread implementation in routine care accompanied by practice-oriented research including service user involvement.

[Normative definition of staff requirement for a guideline-adherent inpatient qualified detoxification treatment in alcohol dependence]

The central element of the "qualified withdrawal treatment" of alcohol dependence is - in addition to physical withdrawal treatment - psychotherapy. The treatment of the underlying addictive disorder that is displayed by intoxication, harmful behaviour and withdrawal symptoms is only possible with a combination of somatic and psychotherapeutic treatment elements. The successfully established multimodal therapy of the "qualified alcohol withdrawal treatment", postulated in the current S3-Treatment Guidelines, requires a multi-disciplinary treatment team with psychotherapeutic competence. The aim of the present work is to calculate the normative staff requirement of a guideline-based 21-day qualified withdrawal treatment and to compare the result with the staffing regulations of the German Institute for Hospital Reimbursement. The present data support the hypothesis that even in the case of a hundred per cent implementation of these data, adequate therapy of alcohol-related disorders, according to the guidelines, is not feasible. This has to be considered when further developing the finance compensation system based on the described superseded elements of the German Institute for Hospital Reimbursement.