Data_Sheet_1_Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland.docx

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany.Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared.Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition.Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.

背景：过去十年，德国和波兰的55个精神病学收容区域见证了灵活整合治疗（FIT）模型的建立。FIT基于全球治疗预算（GTB），该预算整合了为区域人口提供所有急性精神病医院服务的资金。先前的研究已在德国确定了FIT的11个特定项目组件。在本文中，我们旨在评估这些组件在波兰背景下的适用性，并对比分析波兰与德国的FIT实施情况。
方法：我们对19名波兰FIT模型的项目经理进行了关于11个FIT特定组件适用性的定性访谈。随后，在19个波兰和10个德国FIT模型中收集了关于FIT特定组件的半定量数据。我们评估了每个组件的评级、它们的整体实施程度，并在两国之间进行了比较。在所有研究医院中，收集并比较了服务提供的结构和统计参数。
结果：定性结果表明，德国的FIT特定组件在原则上适用于波兰背景。这允许对组件评级和实施程度的比较评估，显示出德国和波兰FIT模型之间只有细微的差异。这些细微的差异指向了诸如家庭治疗、同伴支持和与非临床及社会福利机构的合作等特定护理方面，这些方面应在组件的定义中进一步整合。
结论：从德国经验中首次定义的FIT特定项目组件，作为一种强大的工具，可以用于衡量和评估整合精神卫生护理在卫生系统内外的实施情况。