Evidence map›Paper›PMID 29731412›Full record

Trial reportThe lancet. Psychiatry2018

Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial.

Dennis Ougrin, Richard Corrigall, Jason Poole, Toby Zundel, Mandy Sarhane, Victoria Slater, Daniel Stahl, Paula Reavey, Sarah Byford, Margaret Heslin and 7 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The lancet. Psychiatry, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed, 10 pooled it
9.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

44 citing papers in PubMed, 10 syntheses or guidelines pooled it, 100 citations in OpenAlex.

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  3. Transitional discharge interventions for people with schizophrenia.The Cochrane database of systematic reviews · 2024
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  5. A systematic review of health state utility values and psychometric performance of generic preference-based instruments for children and adolescents with mental health problems.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 3 institutions in 1 country.

Dennis OugrinDepartment of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK. Electronic address: dennis.ougrin@kcl.ac.uk.
Richard CorrigallSouth London and Maudsley NHS Foundation Trust, London, UK.
Jason PooleSouth London and Maudsley NHS Foundation Trust, London, UK; Department of Psychology, London South Bank University, London, UK.
Toby ZundelSouth London and Maudsley NHS Foundation Trust, London, UK.
Mandy SarhaneSouth London and Maudsley NHS Foundation Trust, London, UK.
Victoria SlaterSouth London and Maudsley NHS Foundation Trust, London, UK.
Daniel StahlDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Paula ReaveyDepartment of Psychology, London South Bank University, London, UK.
Sarah ByfordHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Margaret HeslinHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
John IvensSouth London and Maudsley NHS Foundation Trust, London, UK.
Maarten CrommelinSouth London and Maudsley NHS Foundation Trust, London, UK.
Zahra AbdullaDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Daniel HayesSouth London and Maudsley NHS Foundation Trust, London, UK.
Kerry MiddletonSouth London and Maudsley NHS Foundation Trust, London, UK.
Benita NnadiHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Eric TaylorDepartment of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
South London and Maudsley NHS Foundation Trust · GBKing's College London · GBLondon South Bank University · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care.

methodsEligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust. Patients were assigned 1:1 to either the SDS or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. The primary outcome was number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children's Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat. Cost-effectiveness was explored with acceptability curves based on CGAS scores and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life (EQ-5D-3L), taking a health and social care perspective. This study is registered with the ISRCTN Registry, number ISRCTN82129964.

findingsHospital use at 6 months was significantly lower in the SDS group than in the usual care group (unadjusted median 34 IQR 17-63 vs 50 days, 19-125, p=0·04). The ratio of mean total inpatient days for usual care to SDS was 1·67 (95% CI 1·02-2·81, p=0·04), which decreased to 1·65 (0·99-2·77, p=0·057) when adjusted for differences in hospital use before randomisation. Scores for SDQ and CGAS did not differ between groups. The cost-effectiveness acceptability curve based on QALYs showed that the probability of SDS being cost-effective compared with usual care was around 60% with a willingness-to-pay threshold of £20 000-30 000 per QALY, and that based on CGAS showed at least 58% probability of SDS being cost-effective compared with usual care irrespective of willingness to pay. We recorded no adverse events attributable to SDS or usual care.

interpretationSDS provided by an intensive community treatment team reduced bed usage at 6 months' follow-up but had no effect on functional status and symptoms of mental health disorders compared with usual care. The possibility of preventing admissions, particularly through features such as reduced self-harm and improved reintegration into school, with intensive community treatment should be investigated in future studies.

fundingSouth London and Maudsley NHS Trust.

Indexed as

Community Mental Health ServicesCost-Benefit AnalysisEmergency Services, PsychiatricAdolescentChildFemaleHumansMaleMental DisordersNeuropsychological TestsPatient DischargeQuality of Life

Identifiers

PMID29731412
PMCPMC5994473
OpenAlexW2799609585

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.