Economic Evaluation of a Novel Physical Healthcare Advice and Guidance Service in a Mental Health Trust
Notice bibliographique
Résumé
Aims: People with severe mental illnesses experience poorer physical health outcomes compared with the general population, partially related to fragmented care. The Integrating our Mental and Physical Healthcare Systems project implemented an Advice and Guidance Line, supported by colleagues in King’s Health Partners, using the Consultant Connect (CC) app in the South London and Maudsley NHS Foundation Trust to enhance collaborative physical healthcare. This study evaluates the app’s impact on inpatient transfers from mental health wards to acute hospitals, focusing on clinical outcomes and cost savings. Methods: This cost-minimisation analysis used retrospective observational data to analyse electronic health records across a 42-month period (21 months pre- and post-intervention) centred on the CC introduction date in June 2020. The study population was Trust adult inpatients during the study period. Outcome measures were the number of Trust inpatients who attended ED in, or were admitted to, one of the four acute NHS Trusts serving the catchment area. Transfers with a primary COVID-19 diagnosis were excluded. Outcomes are presented as the number of transfers per Trust inpatient bed-year. This divisor accounts for the decrease in bed-days during the pandemic. Results: In the pre-CC period there were 5,472 Trust inpatients across 7,308 inpatient episodes (1,328.78 bed-years) with 1,834 ED transfers. Post-CC the Trust had 5,362 inpatients across 7,396 episodes (1,183.06 bed-years) with 530 ED transfers. The number of ED transfers per bed-year was 1.38 in the pre-CC period, and 0.45 in the post-CC period, a 68% reduction (p<0.001, Chi-square). Interrupted time-series analysis confirmed this decrease (−0.752, 95%CI [−1.117, −0.386], p<0.001). There was no significant difference in admission rates pre- and post-intervention. Based on recent annual bed occupancy (720.97 bed-years) and costs (£457 per ED transfer), CC prevents approximately 670 transfers annually, generating total Trust savings of £241,720 after deducting annual service costs (£61,698) and annualised implementation costs (£3,000). Conclusion: While the pandemic contributed to an initial decrease in ED transfers, the reduction was sustained even as overall ED presentations at the four hospitals returned to pre-pandemic levels. There was no change in admissions to acute Trusts, suggesting that the level of care provided was appropriate to need. The Advice and Guidance model appears cost-effective in managing physical health within mental health settings. These findings support wider implementation of similar services across mental health trusts, though further evaluation in a post-pandemic context is warranted.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».