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Impacts of Community-Based Rehabilitation on Healthcare Utilization and Costs Among People With Schizophrenia in
Ruoxi Ding1,2, Miaomiao Zhao3,4, Yiqi Xia2,5
1Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China.
Background:
Schizophrenia is a leading global disability, with severe treatment gaps in low-resource settings. Community-based rehabilitation (CBR) is promising but lacks robust evidence on its impacts on healthcare utilization.
Study Methods:
We conducted a cluster-randomized controlled trial across 18 urban and rural subdistricts in Weifang City, Shandong province, China, enrolling 334 participants with schizophrenia. Communities were randomly assigned to receive either facility-based care (FBC) enhanced with CBR (n = 172) or standard FBC alone (n = 162). The main outcomes of this study included outpatient/inpatient utilization, costs, and self-treatment over 6- and 12-month follow-up periods, collected through medical insurance claims and structured questionnaires. We systematically monitored intervention quality using the validated Comprehensive Psychotherapeutic Interventions Rating Scale.
Study Results:
At 6 months, CBR participants had significantly lower outpatient costs vs. controls (total: -CNY748.6 [82.4% reduction], 95%CI, -1124.3 to -373.0; schizophrenia-specific: -CNY529.0 [79.1% reduction], -833.5 to -224.4) and reduced out-of-pocket (OOP) costs (total: -CNY216.9; schizophrenia-related: -CNY113.2). By 12 months, inpatient cost reductions emerged (total: -CNY1710.4 [78.2% reduction]; OOP: -CNY405.8 [78.1% reduction]) despite similar admission rates. Self-treatment increased (0.77 more episodes) with no cost differences. Higher quality predicted greater outpatient visit reductions at 12 months (β = -0.10) and inpatient visit reductions at 6 months (β = -0.21), with group dynamics and directive behaviors most beneficial.
Conclusion:
CBR significantly reduces healthcare costs and improves self-management. Quality-driven effects on utilization support scaled implementation in resource-limited settings, particularly via group-based approaches. Integrating high-quality CBR is critical to curb the rising economic burden in low-resource countries.
Trial Registration:
ClinicalTrials.gov identifier: ChiCTR2200066945.
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