OBJECTIVE:To evaluate the impact of child and adolescent mental health services (CAMHS) transformation in South East England on patient access, resource utilisation and health outcomes. DESIGN:In an observational study, we use difference-in-differences analysis with propensity score matching to analyse routinely collected patient level data. SETTING:Three CAMHS services in South East England. PARTICIPANTS:All patients attending CAMHS between April 2012 and December 2018, with more than 57 000 spells of care included. MAIN OUTCOME MEASURES:The rate and volume of people accessing CAMHS; waiting times to the first contact and waiting times between the first and second contact; and health outcomes, including the Strengths and Difficulties Questionnaire (SDQ) and the Revised Child Anxiety and Depression Scale (RCADS). RESULTS:The intervention led to 20% (incidence rate ratio: 1.20; 95% CI: 1.15 to 1.24) more new patients starting per month. There was mixed evidence on waiting times for the first contact. The intervention led to 10% (incidence rate ratio: 1.10; 95% CI: 1.02 to 1.18) higher waiting time for the second contact. The number of contacts per spell (OR: 1.08; 95% CI: 0.94 to 1.25) and the rereferral rate (OR: 1.06; 95% CI: 0.96 to 1.17) were not significantly different. During the post intervention period, patients in the intervention group scored on average 3.3 (95% CI: -5.0 to -1.6) points lower on the RCADS and 1.0 (95% CI: -1.8 to -0.3) points lower on the SDQ compared with the control group after adjusting for the baseline score. CONCLUSIONS:Overall, there are signs that transformation can help CAMHS achieve the objectives of greater access and improved health outcomes, but trade-offs exist among different performance metrics, particularly between access and waiting times. Commissioners and providers should be conscious of any trade-offs when undertaking service redesign and transformation.

译文

目的:评估英格兰东南部的儿童和青少年心理健康服务(CAMHS)转型对患者获取,资源利用和健康结果的影响。
设计:在一项观察性研究中,我们使用差异评分分析和倾向得分匹配来分析常规收集的患者水平数据。
地点:英格兰东南部的三项CAMHS服务。
参加者:2012年4月至2018年12月期间参加CAMHS的所有患者,包括超过5.7万例护理。
主要观察指标:访问CAMHS的人数和数量;第一联系人的等待时间以及第一联系人和第二联系人之间的等待时间;和健康结果,包括优势和困难问卷(SDQ)和修订后的儿童焦虑和抑郁量表(RCADS)。
结果:干预导致每月开始增加新患者20%(发生率:1.20; 95%1.CI:1.15至1.24)。关于首次联系的等待时间,有各种各样的证据。干预导致第二次接触的等待时间增加10%(发生率:1.10; 95%CI:1.02至1.18)。每个咒语的接触次数(OR:1.08; 95%CI:0.94至1.25)和引荐率(OR:1.06; 95%CI:0.96至1.17)没有显着差异。在干预后的期间,干预组的患者在RCADS上平均得分低3.3分(95%CI:-5.0至-1.6),在SDQ上平均得分低1.0(95%CI:-1.8至-0.3)得分。调整基线得分后,再与对照组进行比较。
结论:总的来说,有迹象表明,转型可以帮助CAMHS实现更多获取和改善健康结果的目标,但是在不同的绩效指标之间存在权衡,特别是在获取和等待时间之间。专员和提供者在进行服务重新设计和转换时应意识到任何权衡取舍。

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