PMID- 33383484
OWN - NLM
STAT- MEDLINE
DCOM- 20210524
LR  - 20210524
IS  - 1873-5347 (Electronic)
IS  - 0277-9536 (Linking)
VI  - 270
DP  - 2021 Feb
TI  - Episode detection based on personalized intensity of care thresholds: a 
      schizophrenia case study.
PG  - 113507
LID - S0277-9536(20)30726-7 [pii]
LID - 10.1016/j.socscimed.2020.113507 [doi]
AB  - BACKGROUND: Schizophrenia Spectrum Disorder (SSD) is characterized by its 
      chronic, episodic nature. The clear definition of such episodes is essential for 
      various clinical and research purposes. Most current definitions of episodes in 
      SSD are based on either hospitalizations or on symptom scales. Both have 
      drawbacks; symptom scales are measured infrequently, while hospitalization rates 
      are often affected by policy. This study presents an approach for defining 
      episodes in healthcare data that does not suffer such drawbacks. METHODS: 
      Healthcare use of 13,155 SSD patients in the Northern Netherlands with up to 12 
      years of follow-up was available. Patient-level structural changes in the trend 
      of healthcare use costs were determined using Exponentially Weighted Moving 
      Average (EWMA) control charts. Control charts restart with updated parameters 
      after a detected structural change. Episodes were defined using these structural 
      changes. The resulting episodes were validated by investigating their association 
      with the Global Assessment of Functioning (GAF) scale. RESULTS: The mean number 
      of episodes was 0.61 (sd: 0.60) per patient per year. For the sub-group without 
      hospitalizations this was 0.51 (sd: 0.71). Average episode duration of the 
      sub-group (147 days, sd: 309.4) was similar to that of the full sample (150 days, 
      sd: 305.5). A significant inverse association was identified between GAF scores 
      and the episode-state indicator. CONCLUSIONS: The repeated application of EWMA 
      control charts based on healthcare-intensity is a feasible and promising tool for 
      quantifying patient-level healthcare episodes. The validation using GAF scores 
      indicates that our episode indicator is associated with lower levels of global 
      functioning. Results for individuals without hospitalizations indicate that the 
      method is robust with regard to changes in healthcare policy.
CI  - Copyright (c) 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Konings, Stefan R A
AU  - Konings SRA
AD  - University of Groningen, University Medical Center Groningen, Department of 
      Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation 
      (ICPE), Groningen, the Netherlands. Electronic address: s.r.konings@umcg.nl.
FAU - Bruggeman, Richard
AU  - Bruggeman R
AD  - University of Groningen, University Medical Center Groningen, University Center 
      for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands.
FAU - Visser, Ellen
AU  - Visser E
AD  - University of Groningen, University Medical Center Groningen, University Center 
      for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands.
FAU - Schoevers, Robert A
AU  - Schoevers RA
AD  - University of Groningen, University Medical Center Groningen, Department of 
      Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation 
      (ICPE), Groningen, the Netherlands.
FAU - Mierau, Jochen O
AU  - Mierau JO
AD  - University of Groningen, Faculty of Economics and Business, Groningen, the 
      Netherlands; Aletta Jacobs School of Public Health, Groningen, the Netherlands.
FAU - Feenstra, Talitha L
AU  - Feenstra TL
AD  - University of Groningen, Faculty of Science and Engineering, Groningen Research 
      Institute of Pharmacy, Groningen, the Netherlands; Center for Nutrition, 
      Prevention and Health Services Research, National Institute for Public Health and 
      the Environment (RIVM), Bilthoven, the Netherlands; University of Groningen, 
      University Medical Center Groningen, Department of Epidemiology, Groningen, the 
      Netherlands.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201107
PL  - England
TA  - Soc Sci Med
JT  - Social science & medicine (1982)
JID - 8303205
SB  - IM
MH  - Hospitalization
MH  - Humans
MH  - Netherlands
MH  - *Schizophrenia/diagnosis/therapy
OTO - NOTNLM
OT  - Control charts
OT  - Episodes
OT  - Healthcare use
OT  - Mental illness
OT  - Observational data
OT  - Schizophrenia
OT  - Statistical methods
OT  - Time series
EDAT- 2021/01/01 06:00
MHDA- 2021/05/25 06:00
CRDT- 2020/12/31 20:16
PHST- 2020/10/07 00:00 [revised]
PHST- 2020/11/05 00:00 [accepted]
PHST- 2021/01/01 06:00 [pubmed]
PHST- 2021/05/25 06:00 [medline]
PHST- 2020/12/31 20:16 [entrez]
AID - S0277-9536(20)30726-7 [pii]
AID - 10.1016/j.socscimed.2020.113507 [doi]
PST - ppublish
SO  - Soc Sci Med. 2021 Feb;270:113507. doi: 10.1016/j.socscimed.2020.113507. Epub 2020 
      Nov 7.