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Interrupted time series and synthetic control study to evaluate mental health decision units in acute care pathways: design and protocol.

Abstract

Objectives: Rigorous, comprehensive assessment of MDHUs using non-trial methods to provide an evidence base for their effectiveness, value for money and optimum configuration. Background: Acute crisis care is a difficult area in which to run a randomised controlled trial. There is interest in alternative research methods. The setting of this research project is Mental Health Decision Units (MDHUs). They provide dedicated 24-hour facilities for enhanced mental health assessment, offering short-term support targeting people for whom inpatient admission is being considered with the aim of putting alternative treatment in place. These have been developed in response to the pressure on acute mental health care internationally. Methods: A mixed methods study. We will present the research methods: i) interrupted time series (ITS) design, using routinely collected healthcare data, to explore change in acute and psychiatric hospital activity after the introduction of MHDUs at four partner sites. ii) ITS study with a synthetic control iii) cohort study comparing usage of mental health services preceding and following a patient’s first stay on an MDHU, iv) qualitative study; v) economic analysis plan using typical ‘stories’ of service use constructed from the qualitative study. Results and Conclusions: We present a methodologically sophisticated approach to research, applied to an area in randomised controlled trials are difficult to run. This will be the first formal evaluation of MHDU services in England and the only project to date that includes comparison of different MHDUs, enabling us to identify and model optimum configuration and scale up of MDHUs.
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Background: Acute crisis care is a difficult area in which to run a randomised
controlled trial. There is interest in alternative research methods. The setting of this
research project is Mental Health Decision Units (MDHUs). They provide dedicated
24-hour facilities for enhanced mental health assessment, offering short-term
support targeting people for whom inpatient admission is being considered with the
aim of putting alternative treatment in place. These have been developed in
response to the pressure on acute mental health care internationally.
Results and Conclusions: This will be the first formal
evaluation of MHDU services in England and the only
project to date that includes comparison of different
MHDUs, enabling us to identify and model optimum
configuration and scale up of MDHUs.
Routinely collected healthcare data will be analysed to explore change in acute
and psychiatric hospital activity after the introduction of MHDUs at four sites using
interrupted time series and synthetic control methods.
Control is 'synthetic',
using data from a
donor pool of similar
sites
INTERRUPTED TIME SERIES AND
SYNTHETIC CONTROL STUDY TO
EVALUATE MENTAL HEALTH DECISION UNITS IN ACUTE
CARE PATHWAYS: DESIGN AND PROTOCOL
Methods:
... We will use an interrupted time series design, supplemented by a synthetic control study [32]. Adults (over 18) in psychiatric crisis in England of both sexes are eligible. ...
Article
Full-text available
Background: The UK mental health system is stretched to breaking point. Individuals presenting with mental health problems wait longer at the ED than those presenting with physical concerns and finding a bed when needed is difficult – 91% of psychiatric wards are operating at above the recommended occupancy rate. To address the pressure, a new type of facility – psychiatric decision units (also known as mental health decision units) – have been introduced in some areas. These are short-stay facilities, available upon referral, targeted to help individuals who may be able to avoid an inpatient admission or lengthy ED visit. To advance knowledge about the effectiveness of this service for this purpose, we will examine the effect of the service on the mental health crisis care pathway over a 4-year time period; the 2 years proceeding and following the introduction of the service. We use aggregate service level data of key indicators of the performance of this pathway. Methods: Data from four mental health Trusts in England will be analysed using an interrupted time series (ITS) design with the primary outcomes of the rate of (i) ED psychiatric presentations and (ii) voluntary admissions to mental health wards. This will be supplemented with a synthetic control study with the same primary outcomes, in which a comparable control group is generated for each outcome using a donor pool of suitable National Health Service Trusts in England. The methods are well suited to an evaluation of an intervention at a service delivery level targeting population-level health outcome and the randomisation or ‘trialability’ of the intervention is limited. The synthetic control study controls for national trends over time, increasing our confidence in the results. The study has been designed and will be carried out with the involvement of service users and carers. Discussion: This will be the first formal evaluation of psychiatric decision units in England. The analysis will provide estimates of the effect of the decision units on a number of important service use indicators, providing much-needed information for those designing service pathways.
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