Does community management for patients with severe mental disorders have any effects? An evaluation study based on 134 742 patients in western China

Abstract Background China has established the community-based management and rehabilitation system (CBMRS) for patients with severe mental disorders as one of the primary public health services since in 2009, and enacted a surveillance database system (SDS) in 2011. High-risk behaviour and stable condition of patients are two key surveillance indicators officially required in the management process. However, rare evidence has reported the actual efficiency of the CBMRS. Methods 134 742 (86·5%) of 155 842 patients from Sichuan province in the SDS during 2006–13 were included in the study. Based on a retrospective follow-up design, we calculated the two official indicators and two other related but not officially required indicators, medication adhesive and clinic effective, at two timepoints: beginning of entering and exit of the CBMRS system. We estimated the difference in each outcome measure between the two timepoints using two-level multilevel regression models adjusted for patients' demographics and time period between the two timepoints. We estimated and tested variations in each outcome across 141 counties at the two timepoints and using F test to assess consistency of the measurement over time. Findings The official indicator, high-risk behaviour, showed a reduction after model adjustment from 1·5% down to 0·2% (p Interpretation The official evaluation indicators focused on end results, which might have inflated the management effects in the CBMRS. New evaluation indicators that focus on the management process should be considered. Funding China Medical Board (CMB 12-106; CMB 16-252).