Skip to main content
SpringerLink
Log in

Akut-Tagesklinik als kosteneffiziente Alternative zu stationärer Therapie

Acute day hospital as a cost-effective alternative to inpatient therapy

  • originalarbeit
  • Published:
neuropsychiatrie Aims and scope Submit manuscript

An Erratum to this article was published on 07 April 2017

Zusammenfassung

Grundlagen

Es handelt sich um eine Untersuchung des Kosten-Nutzen-Vorteils des Modellprojektes Akut-Tagesklinik (ATK) im Vergleich zur stationären Versorgung.

Methodik

Die Studie wurde retrospektiv durchgeführt und untersuchte die direkten Kosten und das Global Assessment of Functioning (GAF) in einem gematchten Sample.

Ergebnisse

Die tagesklinische Behandlung zeigte im Vergleich zur stationären Therapie einen Kostenvorteil von 2,68:1 bei einem etwas verzögerten Anstieg des GAF-Wertes.

Schlussfolgerung

Die Behandlung in der ATK ist eine mehr als doppelt so günstige Alternative zur stationären Therapie, jedoch mit einer etwas langsameren Verbesserung der Symptomatik.

Summary

Background

This is a study of the cost-benefit advantage of the model project acute day hospital (ATK) compared to inpatient care.

Methods

The study was performed retrospectively and examined the direct costs and the Global Assessment of Functioning (GAF) in a matched sample.

Results

The day clinic treatment compared to inpatient therapy showed at a cost benefit of 2.68: 1 at a slightly delayed increase in GAF-value.

Conclusion

The treatment in ATK is more than twice as cheap compared to inpatient treatment, but at a slightly slower improvement in symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Böker H, Hell D, Teichman D. Teilstationäre Behandlung von Depressionen, Angst- und Zwangsstörungen. Stuttgart: Schattauer; 2009.

    Google Scholar 

  2. Schene AH, van Lieshout PA, Mastboom JC. Different types of partial hospitalization programs: results of a nationwide survey in The Netherlands. Acta Psychiatr Scand. 1988;78:515–22.

    Article  CAS  PubMed  Google Scholar 

  3. Kallert TW, Schützwohl M, Matthes C. Current structural and procedural quality markers of psychiatric day hospitals in Germany. Psychiatr Prax. 2003;30:72–82.

    Article  PubMed  Google Scholar 

  4. Bundesgesetz über die Krankenversicherung (KVG). 18. März 1994 (Stand 1. Jan. 2017). Gesehen Januar 2017.

  5. Kallert TW, Glockner M, Priebe S, et al. A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research. Soc Psychiatry Psychiatr Epidemiol. 2004;39:777–88.

    Article  PubMed  Google Scholar 

  6. Creed F, Mbaya P, Lancashire S, et al. Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial. BMJ. 1997;314:1381–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Marshall M, Crowther R, Almaraz-Serrano A, et al. Day hospital versus admission for acute psychiatric disorders. Cochrane Database Syst Rev. 2003; doi:10.1002/14651858.cd004026.

    Google Scholar 

  8. Priebe S, McCabe R, Schützwohl M, et al. Patient characteristics predicting better treatment outcomes in day hospitals compared with inpatient wards. Psychiatr Serv. 2011;62:278–84.

    Article  PubMed  Google Scholar 

  9. Creed F, Black D, Anthony P, et al. Randomised controlled trial of day patient versus inpatient psychiatric treatment. BMJ. 1990;300:1033–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dick P, Cameron L, Cohen D, et al. Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry. 1985;147:246–9.

    Article  CAS  PubMed  Google Scholar 

  11. Herz MI, Endicott J, Spitzer RL, Mesnikoff A. Day versus inpatient hospitalization: a controlled study. Am J Psychiatry. 1971;127:1371–82.

    Article  CAS  PubMed  Google Scholar 

  12. Kallert TW, Matthes C, Glöckner M, et al. Acute psychiatric day hospital treatment: is the effectiveness of this treatment approach still questionable? Psychiatr Prax. 2004;31:409–19.

    Article  PubMed  Google Scholar 

  13. Kluiter H, Giel R, Nienhuis FJ, et al. Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: results of a randomized trial. Am J Psychiatry. 1992;149:1199–205.

    Article  CAS  PubMed  Google Scholar 

  14. Kris EB. Day hospitals. Curr Ther Res Clin Exp. 1965;7:320–3.

    CAS  PubMed  Google Scholar 

  15. Nienhuis FJ, Giel R, Kluiter H, et al. Efficacy of psychiatric day treatment. Course and outcome of psychiatric disorders in a randomised trial. Eur Arch Psychiatry Clin Neurosci. 1994;244:73–80.

    Article  CAS  PubMed  Google Scholar 

  16. Schene AH, van Wijngaarden B, Poelijoe NW, Gersons BP. The Utrecht comparative study on psychiatric day treatment and inpatient treatment. Acta Psychiatr Scand. 1993;87:427–36.

    Article  CAS  PubMed  Google Scholar 

  17. Sledge WH, Tebes J, Rakfeldt J, et al. Day hospital/crisis respite care versus inpatient care, Part I: clinical outcomes. Am J Psychiatry. 1996;153:1065–73.

    Article  CAS  PubMed  Google Scholar 

  18. Sledge WH, Tebes J, Wolff N, Helminiak TW. Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs. Am J Psychiatry. 1996;153:1074–83.

    Article  CAS  PubMed  Google Scholar 

  19. Wiersma D, Kluiter H, Nienhuis FJ, et al. Costs and benefits of hospital and day treatment with community care of affective and schizophrenic disorders. Br J Psychiatry Suppl. 1995;27:52–9.

    Google Scholar 

  20. Zwerlingi I, Wilder JF. An evaluation of the applicability of the day hospital in treatment of acutely disturbed patients. Isr Ann Psychiatr Relat Discip. 1964;2:162–85.

    CAS  PubMed  Google Scholar 

  21. Davidson L, Tebes JK, Rakfeldt J, Sledge WH. Differences in social environment between inpatient and day hospital-crisis respite settings. Psychiatr Serv. 1996;47:714–20.

    Article  CAS  PubMed  Google Scholar 

  22. Wunner C, Reichhart C, Strauss B, Söllner W. Effectiveness of a psychosomatic day hospital treatment for the elderly: a naturalistic longitudinal study with waiting time before treatment as control condition. J Psychosom Res. 2014;76:121–6.

    Article  PubMed  Google Scholar 

  23. Russell V, Mai F, Busby K, et al. Acute day hospitalization as an alternative to inpatient treatment. Can J Psychiatry. 1996;41:629–37.

    CAS  PubMed  Google Scholar 

  24. Kallert TW, Priebe S, McCabe R, et al. Are day hospitals effective for acutely ill psychiatric patients? A European multicenter randomized controlled trial. J Clin Psychiatry. 2007;68:278–87.

    Article  PubMed  Google Scholar 

  25. Beck A, Croudace TJ, Singh S, Harrison G. The Nottingham acute bed study: alternatives to acute psychiatric care. Br J Psychiatry. 1997;170:247–52.

    Article  CAS  PubMed  Google Scholar 

  26. Gesundheitsdirektion, Kanton Zürich. Handbuch PSYREC-KTR-Erhebung. Version 5.0. http://www.gd.zh.ch/dam/gesundheitsdirektion/direktion/themen/gesundheitsinstitutionen/spitaeler_kliniken/handbuecher_vorgaben_erhebungsunterlagen/handbuecher_und_vorgaben/psyrec-ktr/handbuch_psyrec_v5.0.pdf.spooler.download.1468305951300.pdf/handbuch_psyrec_v5.0.pdf. Zugegriffen: 17.01.2017.

  27. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5. Aufl. Washington DC: American Psychiatric Press; 1994.

    Google Scholar 

  28. Schützwohl M, Kallert T. Comparison of clinical and social outcome of a) legally involuntarily admitted patients and b) of legally voluntarily admitted patients who feel coerced to admission across the EUNOMIA study sites. BMC Psychiatry. 2007;7:S98.

    Article  PubMed Central  Google Scholar 

  29. Nawka A, Kalisova L, Raboch J, et al. Gender differences in coerced patients with schizophrenia. BMC Psychiatry. 2013;13:257.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Killaspy H, White S, Wright C, et al. Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users’ views. PLOS ONE. 2012;7:e38070.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kastner D, Buchtemann D, Warnke I, et al. Clinical and functional outcome of assertive outreach for patients with schizophrenic disorder: results of a quasi-experimental controlled trial. Eur Psychiatry. 2015;30:736–42.

    Article  CAS  PubMed  Google Scholar 

  32. Warnke I, Rössler W, Nordt C, Herwig U. Assessing a financial incentive for reducing length of stay of psychiatric inpatients: implications for financing psychiatric services. Swiss Med Wkly. 2014;144:w13991.

    PubMed  Google Scholar 

  33. Rössler W, Kawohl W. Soziale Psychiatrie. Das Handbuch für die psychosoziale Praxis. Stuttgart: Kohlhammer; 2013.

    Google Scholar 

  34. Lieb K, Frauenknecht S, Brunnhuber S. Intensivkurs Psychiatrie und Psychotherapie. München: Urban & Fischer; 2012.

    Google Scholar 

  35. Larivière N, Desrosiers J, Tousignant M, Boyer R. Multifaceted impact evaluation of a day hospital compared to hospitalization on symptoms, social participation, service satisfaction and costs associated to service use. Int J Psychiatry Clin Pract. 2011;15:228–40.

    Article  PubMed  Google Scholar 

  36. Psychiatrische Universitätsklinik Zürich. Jahresbericht 2015 Fusion.

  37. Dilling H, Freyberger HJ. Weltgesundheitsorganisation.Taschenführer zur ICD-10-Klassifikation psychischer Störungen. Bern: Huber; 2011.

    Google Scholar 

  38. Kallert TW, Schönherr R, Schnippa S, et al. Direct costs of acute day hospital care: results from a randomized controlled trial. Psychiatr Prax. 2005;32:132–41.

    Article  PubMed  Google Scholar 

Download references

Danksagung

Dem Controlling der PUK Zürich und insbesondere Herrn Markus Oberle wird für Aufbereitung der Daten der direkten Behandlungskosten herzlich gedankt.

Author information

Authors and Affiliations

  1. Klinik für Psychiatrie, Psychotherapie und Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz

    Kunigunde Pausch, Carlos Nordt & Erich Seifritz

  2. Psychiatrische Dienste Aargau (PDAG), Aargau, Schweiz

    Eva-Maria Pichler & Wolfram Kawohl

  3. Forensisch-Psychiatrischer Dienst (FPD), Institut für Rechtsmedizin, Universität Bern, Bern, Schweiz

    Ingeborg Warnke

Authors
  1. Kunigunde Pausch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Nordt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva-Maria Pichler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ingeborg Warnke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erich Seifritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolfram Kawohl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kunigunde Pausch.

Ethics declarations

Interessenkonflikt

K. Pausch ist die ärztliche Leiterin der Akut-Tagesklinik der PUK Zürich. W. Kawohl war Leiter des Zentrums für soziale Psychiatrie der PUK Zürich bis September 2016. C. Nordt, E.-M. Pichler, I. Warnke und E. Seifritz geben an, dass kein Interessenkonflikt besteht.

Ethische Standards

Die Durchführung der Studie wurde durch die kantonale Ethikkommission Zürich genehmigt.

Additional information

Die ursprüngliche Online-Version dieses Artikels wurde geändert: Abb. 1 wurde leider nicht korrekt abgebildet.

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s40211-017-0224-3 zu finden.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pausch, K., Nordt, C., Pichler, EM. et al. Akut-Tagesklinik als kosteneffiziente Alternative zu stationärer Therapie. Neuropsychiatr 31, 63–69 (2017). https://doi.org/10.1007/s40211-017-0221-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40211-017-0221-6

Schlüsselwörter

Keywords

Search

Navigation