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Evaluating the use of Community Treatment Orders in England

ENCORE is the short title for EvaluatiNg the Use of Community Treatment ORders in England study.

Community Treatment Orders (CTOs) were introduced in England in 2008 with the purpose of reducing rates of readmission to hospital for patients experiencing serious mental illness.

Health service data suggests certain types of patient are more likely to be placed on CTOs and that CTOs are commonly used in some places and not others. It is not clear from existing research if CTOs help reduce hospital readmissions and whether they have other positive, or negative, effects on patients.

The study will centre on the analysis of four years of anonymised patient records and there are four work packages that link to the main aims of the study:

  1. The first will look at differences over time and between places in the use of CTOs. As well as looking at differences in the chance of patients being put on CTOs, we will also look at differences in the chance of patients having their CTOs reviewed or stopped.
  2. The second will examine associations between CTO use and a range of patient outcomes. The outcomes will include measures of health service use such as hospital readmission as well as other measures relating to patient well-being such as accidents, emergencies and fatalities.
  3. The third will examine variations in the associations between use and outcomes for different patients, places and providers. CTO-related outcomes may be different in different types of places for different types of patients.

As CTOs involve patients liaising with many health service professionals and undertaking various administrative procedures, the final work package will provide estimates of the financial costs associated with their use. The work packages are shown in a diagram below to show how the research activities fit together.

Funder: National Institute of Health Research (NIHR) Health Services and Delivery Research  (HS&DR) Programme (HS&DR), 24 months (commenced March 2016)

Non-Academic Partner: Mental Health Foundation

External Academic Collaborators: University of Sheffield, University of Warwick, University of Portsmouth, University of Southampton, Barts & The London Queen Mary's School of Medicine & Dentistry, and Newcastle University.

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