Needs-oriented discharge planning and monitoring for high utilisers of psychiatric services (NODPAM): Design and methods

Bernd Puschner¹ , Sabine Steffen¹ , Wolfgang Gaebel² , Harald Freyberger³ , Helmfried E Klein⁴ , Tilman Steinert⁵ , Rainer Muche⁶ and Thomas Becker¹

¹Department of Psychiatry II, Ulm University, BKH Günzburg, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany

²Department of Psychiatry and Psychotherapy, Heinrich-Heine-University Düsseldorf, Bergische Landstr. 2, 40629 Düsseldorf, Germany

³Department of Psychiatry and Psychotherapy, Greifswald University, Rostocker Chaussee 70, 18437 Stralsund, Germany

⁴Department of Psychiatry and Psychotherapy, Regensburg University, Universitätsstr. 84, 93053 Regensburg, Germany

⁵Department of Psychiatry I, Ulm University, Ravensburg, Weingartshofer Str. 2, 88214 Ravensburg, Germany

⁶Institute for Biometrics, Ulm University, Schwabstr. 13, 89075 Ulm, Germany

author email corresponding author email

BMC Health Services Research 2008, 8:152doi:10.1186/1472-6963-8-152


Published:	21 July 2008

Abstract

Background

Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.

Methods

This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points.

The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session.

Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.

Discussion

If a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.

Trial Registration

ISRCTN59603527