Background. It is widely believed that for the severely
mentally ill continuity of care is essential to
ensure a better outcome and prevent long-term hospitalization. However,
much progress has
been made in the operationalization and measurement of this concept. We
two indicators to
compare continuity of care of schizophrenic patients in two kinds of mental
health systems. One is
a community mental health system without the back-up of a mental hospital
The other is an institution-based system in which mental hospitals are
predominant (Groningen, The Netherlands).
Methods. The first indicator of continuity of care, readiness
aftercare, is the time from discharge
from hospital to the first day- or out-patient contact. Survival analysis
applied to correct for
censored observations. The second indicator, flexibility of care, is the
of combinations of in-, day- and out-patient care during 2-year follow-up.
Results. More patients in South-Verona received community care
within 2 weeks after discharge
(71·5%), than in the Groningen register area (54·6%). The
survival functions differed significantly.
Cox regression analysis revealed that in both systems a contact before
admission, the time between
this contact and admission and the duration of the admission are predictors
for aftercare. A higher
percentage of patients made multiple service use (combinations of in-,
day- and out-patient care) in
South-Verona than in Groningen (62 v. 45%).
Conclusions. Both indicators showed a higher continuity of
in the South-Verona system.