Intensive home treatment compared to inpatient psychiatric treatment: a 36-month follow-up of a propensity-score matched retrospective multicenter cohort study.

backgroundIntensive Home Treatment (IHT) has been implemented as an alternative to inpatient psychiatric treatment for selected patients requiring acute care. While short-term reductions in inpatient utilization have been reported, evidence on long-term outcomes beyond 12 months—particularly regarding readmissions, treatment days, and broader psychiatric service use—remains limited. This study evaluates the 36-month effectiveness of IHT compared to inpatient treatment (IT) in routine care, focusing on readmission rates, treatment days, and outpatient service engagement.

methodsWe conducted a retrospective propensity-score matched cohort study using routine clinical data from three psychiatric hospitals in Berlin, Germany. Patients receiving IHT were matched (1:1) to patients receiving IT based on age, gender, diagnosis, and prior service utilization. Outcomes included inpatient and combined readmissions (IT, IHT and day clinic), treatment days, time to readmission, and first-time use of the Psychiatric Outpatient Department (POD) over 36 months. Statistical analyses included binary logistic regression, Kaplan–Meier survival analysis with log-rank testing, and non-parametric tests.

results263 patients receiving IHT were matched to 263 patients treated with IT, with no statistical differences at baseline between groups. The IHT group had significantly lower inpatient readmission rates (41.1% vs. 55.5%, p = 0.001), fewer inpatient readmissions (mean 1.72 vs. 2.02, p = 0.005), and fewer inpatient days (48.5 vs. 51.7, p = 0.003) compared to IT over 36 months. Time to readmission was longer for IHT (median not reached vs. 610 days for IT, p = 0.001). Combined readmission rates (IHT + IT+day clinic) did not differ significantly (61.2% vs. 64.3%, p = 0.47). IHT patients were more likely to initiate for the first time a POD treatment (33.5% vs. 24.7%, p = 0.035) and had more IHT readmissions (mean 0.85 vs. 0.35, p < 0.001).

conclusionsIn this selected cohort of patients deemed suitable for home-based acute care, IHT was associated with fewer inpatient readmissions and a longer time to inpatient readmission over a 36-month follow-up period. Overall acute psychiatric care use (inpatient + IHT) did not differ between groups, suggesting that IHT may not reduce overall acute care need but may shift care from inpatient settings toward home-based treatment.These findings should be interpreted cautiously given the non-randomized study design and the likelihood of residual selection bias. Limitations include restricted generalizability to rural areas and lack of clinical symptom data. Further multi-centre studies are needed to confirm these results regarding long-term effects across diverse healthcare systems.

trial registrationGerman Clinical Trials Register (DRKS), DRKS00036833. Registered May 21, 2025, https://www.drks.de/search/de/trial/DRKS00036833/details .