Background Mental health services for adults, as they are currently configured, have been designed to provide predominantly community-based interventions. It has long been recognised that some patients have such significant clinical and/or risk needs that those needs cannot be adequately met within standard service delivery models, resulting in a pressing need to consider the best models for this group of people. This paper shares a protocol for a mixed methods study that aims to understand: the profile and history of service users described as having complex needs; the decision-making processes by clinicians that lead to complex needs categorisation; service users and carers experience of service use; and, associated economic impact. This protocol describes a comprehensive evaluation that aims to inform an evidence-based service delivery model for people with complex needs. Methods We will use a mixed methods design, combining quantitative and qualitative methods using in-depth descriptive and inferential analysis of patient records, written medical notes and in-depth interviews with service users, carers, and clinicians. The study will include five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of alternative patient pathways; (3) semi-structured interviews about service user and carer experiences; (4) using data from components 1-3 to co-produce vignettes jointly with relevant stakeholders involved in the care of service users with complex mental health needs; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group, using the vignettes as example case studies. Discussion The studys key outcomes will be to: examine the resource use and cost-impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how treatment decisions are made to inform consistent and person-centred future service delivery.

中文翻译：

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复杂的心理健康PAThways（COMPAT）研究：一项混合方法研究，为具有复杂需求的人们提供基于证据的服务交付模型：研究方案

背景技术当前配置的成人心理健康服务旨在提供主要基于社区的干预措施。长期以来，人们已经认识到某些患者具有如此重大的临床和/或风险需求，以致于在标准的服务提供模型中无法充分满足这些需求，因此迫切需要考虑针对此类人群的最佳模型。本文共享了一项旨在研究混合方法的协议，旨在了解：描述为具有复杂需求的服务用户的概况和历史；临床医生的决策过程导致了复杂的需求分类；服务使用者和护理人员的服务使用经验；以及相关的经济影响。该协议描述了一个综合评估，旨在为具有复杂需求的人们提供基于证据的服务交付模型。方法我们将采用混合方法设计，结合定量和定性方法，对患者病历，书面医疗记录以及与服务使用者，护理人员和临床医生进行深入访谈，进行深入的描述性和推论性分析。该研究将包括五个组成部分：（1）对患者群体的人口统计学临床特征进行定量描述和分析；（2）对替代患者途径的经济评估；（3）关于服务使用者和护理人员经验的半结构化访谈；（4）使用组件1-3中的数据与参与照顾具有复杂精神健康需求的服务使用者的相关利益相关者共同制作渐晕影；和，（5）使用小插图作为案例研究，对临床医生针对该患者群体的临床决策进行半结构化访谈。讨论该研究的主要成果将是：研究与通向NHS和其他经济部门（包括社会护理）的替代护理途径相关的资源使用和成本影响；探索与替代治疗途径相关的患者健康和非健康结果；并且了解复杂的服务用户群，以及如何制定治疗决策以告知一致且以人为本的未来服务交付。审查与通向NHS和其他经济部门（包括社会护理）的替代护理途径相关的资源使用和成本影响；探索与替代治疗途径相关的患者健康和非健康结果；并且了解复杂的服务用户群，以及如何制定治疗决策以告知一致且以人为本的未来服务交付。审查与通向NHS和其他经济部门（包括社会护理）的替代护理途径相关的资源使用和成本影响；探索与替代治疗途径相关的患者健康和非健康结果；并且了解复杂的服务用户群，以及如何制定治疗决策以告知一致且以人为本的未来服务交付。