TY - JOUR
T1 - Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period
AU - Trevillion, Kylee
AU - Shallcross, Rebekah
AU - Ryan, Elizabeth
AU - Heslin, Margaret
AU - Pickles, Andrew
AU - Byford, Sarah
AU - Jones, Ian
AU - Johnson, Sonia
AU - Pawlby, Susan
AU - Stanley, Nicky
AU - Rose, Diana
AU - Seneviratne, Gertrude
AU - Wieck, Angelika
AU - Jennings, Stacey
AU - Potts, Laura
AU - Abel, Kathryn M.
AU - Howard, Louise M.
N1 - Funding Information:
Funding This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number: RP-PG-1210-12002) and the National Institute for Health Research (NIHR) / Wellcome Trust King’s and Manchester Clinical Research Facility. The study team acknowledges the study delivery support given by the national NIHR Clinical Research Networks. This study represents independent research supported by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. LMH is also supported by an NIHR Research Professorship (NIHR-RP-R3-12-011).
Funding Information:
1Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK 2Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK 3Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK 4King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK 5National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, London, UK 6Division of Psychiatry, University College London, London, UK 7Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK 8School of Social Work, Care and Community, University of Central Lancashire, Preston, UK 9Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK 10Psychological Medicine and Integrated Care Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK 11Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK 12Addictions, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK 13Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, Manchester, UK 14Manchester Mental Health & Social Care Trust, Manchester, UK Acknowledgements We gratefully acknowledge the advice received from our Patient and Public Advisory Group (Clare Dolman, Sarah Spring, Ceri Rose, Liberty Mosse, Amanda Grey, Henry Fay, Kathryn Grant, Maria Bavetta, Eleanor O’Sullivan, Jesse Hunt, Diana Rose, chair), our Programme Steering Committee (Rona McCandlish (Chair), Heather O’Mahen, Pauline Slade, Ceri Rose, Sarah Spring and Rosemary Jones) and our Data Monitoring and Ethics Committee (Roch Cantwell (chair), Liz McDonald-Clifford, Marian Knight, Stephen Bremner). We also want to take the opportunity to acknowledge the support of the National Institute of Health Research Clinical Research Networks (NIHR CRN).
Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
PY - 2019/6
Y1 - 2019/6
N2 - Introduction Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs. Methods and analysis Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-Adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother-infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition. Ethics and dissemination The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.
AB - Introduction Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs. Methods and analysis Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-Adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother-infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition. Ethics and dissemination The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.
KW - Cohort study
KW - Cost-effectiveness analysis
KW - Perinatal mental disorder
KW - Propensity scoring
UR - http://www.scopus.com/inward/record.url?scp=85063320119&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2018-025906
DO - 10.1136/bmjopen-2018-025906
M3 - Article
C2 - 30904867
AN - SCOPUS:85063320119
VL - 9
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 3
M1 - e025906
ER -
