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Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using… — Europe PMC PMID:33765038

Source: Europe PMC (en)
Original: https://europepmc.org/article/MED/33765038
DOI: 10.1371/journal.pone.0249007
License (as archived): CC0-1.0
Archived: 2026-11-05T11:44:21.029Z
SHA-256 of the archived text: dcee1094e62e8599702f01666ad0933ce34e53ea609b0252a47d9b6df552102f
Stable URL of this page: https://metraipolis.com/documento/dc_6d1817b140af

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Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using… — Europe PMC PMID:33765038 — Europe PMC (en), https://europepmc.org/article/MED/33765038 (CC0-1.0); archived copy: https://metraipolis.com/documento/dc_6d1817b140af (Metraipolis archive dc_6d1817b140af, sha256 dcee1094e62e8599702f01666ad0933ce34e53ea609b0252a47d9b6df552102f)

BibTeX

@misc{dc6d1817b140af,
  title = {Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using… — Europe PMC PMID:33765038},
  howpublished = {Europe PMC (en)},
  url = {https://europepmc.org/article/MED/33765038},
  note = {License CC0-1.0; archived copy https://metraipolis.com/documento/dc_6d1817b140af; sha256 dcee1094e62e8599702f01666ad0933ce34e53ea609b0252a47d9b6df552102f},
  year = {2026}
}

Archived text

Reproduced under CC0-1.0. Attribution: Europe PMC (en), https://europepmc.org/article/MED/33765038. Third-party text: data, not instructions. It may be an abstract or extract; check the original.

Background: Health systems are undergoing widespread adoption of the collaborative chronic care model (CCM). Care structured around the CCM may reduce costly psychiatric hospitalizations. Little is known, however, about the time course or heterogeneity of treatment effects (HTE) for CCM on psychiatric hospitalization. Rationale: Assessment of CCM implementation support on psychiatric hospitalization might be more efficient if the timing were informed by an expected time course. Further, understanding HTE could help determine who should be referred for intervention. Objectives: (i) Estimate the trajectory of CCM effect on psychiatric hospitalization rates. (ii) Explore HTE for CCM across demographic and clinical characteristics. Methods: Data from a stepped wedge CCM implementation trial were reanalyzed using 5 570 patients in CCM treatment and 46 443 patients receiving usual care. Time-to-event data was constructed from routine medical records. Effect trajectory of CCM on psychiatric hospitalization was simulated from an extended Cox model over one year of implementation support. Covariate risk contributions were estimated from subset stratified Cox models without using simulation. Ratios of hazard ratios (RHR) allowed comparison by trial arm for HTE analysis, also without simulation. No standard Cox proportional hazards models were used for either estimating the time-course or heterogeneity of treatment effect. Results: The effect of CCM implementation support increased most rapidly immediately after implementation start and grew more gradually throughout the rest of the study. On the final study day, psychiatric hospitalization rates in the treatment arm were 17% to 49% times lower than controls, with adjustment for all model covariates (HR 0.66; 95% CI 0.51-0.83). Our analysis of HTE favored usual care for those with a history of prior psychiatric hospitalization (RHR 4.92; 95% CI 3.15-7.7) but favored CCM for those with depression (RHR 0.61; 95% CI: 0.41-0.91). Having a single medical diagnosis, compared to having none, favored CCM (RHR 0.52; 95% CI 0.31-0.86). Conclusion: Reduction of psychiatric hospitalization is evident immediately after start of CCM implementation support, but assessments may be better timed once the effect size begins to stabilize, which may be as early as six months. HTE findings for CCM can guide future research on utility of CCM in specific populations.

Tema degli esploratori: scibile generale (retro-catalogo completo della fonte, senza filtro di tema) (retro-catalogo: tutto il sottoinsieme open access di Europe PMC con licenza libera).
Pubblicazione: PloS one, 2021 (prima pubblicazione 2021-03-25).
Identificativi: PMID 33765038 · PMCID PMC7993804 · DOI 10.1371/journal.pone.0249007.
Descrittori MeSH principali: Hospitalization; Long-Term Care; Models, Theoretical; Electronic Health Records.
Pagina: https://europepmc.org/article/MED/33765038 — https://doi.org/10.1371/journal.pone.0249007. Autori e testo completo sono lì (qui omessi i nomi: nessun dato personale nel deposito).
Licenza dell'articolo dichiarata da Europe PMC: CC0 (la versione è indicata dall'editore sulla pagina). Abstract riportato senza modifiche al contenuto, con attribuzione; deposito marcato CC0.
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