Relapse prevention through health technology program reduces hospitalization in schizophrenia

Homan, P.; Schooler, N. R.; Brunette, M. F.; Rotondi, A.; Ben-Zeev, D.; Gottlieb, J. D.; Mueser, K. T.; Achtyes, E. D.; Gingerich, S.; Marcy, P.; Meyer-Kalos, P.; Hauser, M.; John, M.; Robinson, D. G.; Kane, J. M.

doi:10.1101/626663

bioRxiv · 10.1101/626663

Relapse prevention through health technology program reduces hospitalization in schizophrenia

Homan, P.·Schooler, N. R.·Brunette, M. F.·Rotondi, A.·Ben-Zeev, D.·Gottlieb, J. D.·Mueser, K. T.·Achtyes, E. D.·Gingerich, S.·Marcy, P.·Meyer-Kalos, P.·Hauser, M.·John, M.·Robinson, D. G.·Kane, J. M.

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Abstract

ImportancePsychiatric hospitalization is a major driver of cost in the treatment of schizophrenia. Symptom relapses are a frequent cause of hospitalization and both are primary source of burden to patients and their supporters.\n\nObjectiveTo determine whether a novel, multicomponent, and technology-enhanced approach to relapse prevention in outpatients following a psychiatric hospitalization could reduce days spent in a hospital after discharge.\n\nDesignThe Improving Care and Reducing Cost (ICRC) study was a quasi-experimental clinical trial in outpatients with schizophrenia conducted between February 2013 and April 2015 at 10 different sites in the US. Data were obtained from 89 participants who received usual relapse prevention services, followed by a second cohort of 349 participants who received the technology-enhanced relapse prevention program. Both groups were followed for 6 months.\n\nSettingOutpatient setting.\n\nParticipantsPatients were between 18 and 60 years old; had a diagnosis of schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified; and were currently hospitalized or had been hospitalized within the past 30 days.\n\nInterventionPatients received usual care or a technology-enhanced relapse prevention program during a 6-month period after discharge.\n\nMain Outcome(s) and Measure(s)Days spent in a psychiatric hospital during 6 months after discharge.\n\nResultsThe study included 438 patients. Control participants (N = 89; 37 females) were enrolled first and received usual care for relapse prevention, and followed by 349 participants (128 females) who received technology-enhanced relapse prevention. Days of hospitalization were reduced by 4 days (Mean days: b = -4.25, 95% CI: -8.29; -0.21, P = 0.039) during follow-up in the intervention condition compared to control.\n\nConclusions and RelevanceThe reduction in days spent in the hospital for participants in the technology-informed relapse prevention program compared to those who received usual care, and the previously reported high satisfaction and usability suggest that technology-enhanced relapse prevention is an effective and feasible way to reduce rehospitalization days among patients with schizophrenia.\n\nKey pointsO_ST_ABSQuestionC_ST_ABSCan rehospitalizations in schizophrenia be prevented at reduced cost by innovative mobile technology-delivered interventions?\n\nFindingsIn this clinical trial with 438 patients, a technology-enhanced relapse prevention program compared to usual services reduced an average of four days of hospitalization per patient during the first 6 months following an index hospitalization.\n\nMeaningRelapse prevention through a health technology may improve care while reducing costs associated with hospitalization.

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Homan, P., Schooler, N. R., Brunette, M. F., Rotondi, A., Ben-Zeev, D., Gottlieb, J. D., Mueser, K. T., Achtyes, E. D., Gingerich, S., Marcy, P., Meyer-Kalos, P., Hauser, M., John, M., Robinson, D. G., Kane, J. M.. 2019-05-03. Relapse prevention through health technology program reduces hospitalization in schizophrenia. https://doi.org/10.1101/626663

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