Using Routinely Collected Multi Centre Data to Evaluate Treatment Effect and Cost Factors: The Case of Psychotherapeutic Day Treatment Programs in Norway
Posted: 8 Jul 2007
Date Written: June 12, 2007
Abstract
Background: Patients suffering from personality disorders are known as frequent users of health services. Treatment programs aiming at reducing symptoms and functional maladjustment as well as health service usage in a long term perspective has received much attention. In accordance with the general trend of de-institutionalization in western countries, day hospital treatment has been developed in particular for this patient population as an alternative to inpatient treatment. Different treatment modalities have been implemented concerning treatment context: Treatment intensity (hours per week), duration (number of weeks) and staff size. Results from randomised controlled trials indicates positive effects of day treatment programmes, but at the same time policy makers has been advised to consider how far the costs of providing day treatment programmes can be justified since outpatient treatment appears to be an alternative. From a cost perspective the treatment context is of vital interest since the level of intensity, duration and staff influence cost per patient. In Norway short term day treatment programmes has emerged as a kind of standard leaving variation in treatment context primarily to staff and intensity.
Aim of the study: In this paper we analyse the relationship between patient outcome and three aspects of the treatment context, i.e. staff size, skill mix and treatment intensity. In addition we address the question of location specific effects.
Data and methods: Multi centre data routinely collected under non-experimental conditions from nine units being members of a cooperating network in Norway was analysed applying a multilevel analysis approach. The data set consisted of treatment unit characteristics for the period of 1993 to 2005, constituting an unbalanced panel of 71 units, together with information from 1574 patients who completed day treatment according to the plan. Patient outcome was measured by change in Global Assessment of Functioning Scale (GAF).
Results: Twelve per cent of variation in patient outcome was attributed to the treatment unit level. Staff size and treatment intensity influenced outcome to a minor extent, while an increased share of nurses or other college educated personnel was associated with improved patient outcome. A positive location specific effect attached to a university based unit was found. Potential cost savings seem to be apparent with respect to staff size and to some extent skill mix.
Keywords: Psychotherapeutic day treatment, staff size, patient outcome
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