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CEPHOS-LINK — Comparative Effectiveness Research on Psychiatric Hospitalisation by Record Linkage of Large Administrative Data Sets

CEPHOS-LINK was an EU FP7-project aimed at comparing different types of health service interventions in terms of differences in rehospitalisation outcomes in adult patients, who have been discharged with a psychiatric diagnosis from hospital.

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CEPHOS-LINK used state-of-the-art approaches using large 'real world' electronic databases allowing for specific comparisons and detailed analysis to be made.

Prevent re-hospitalisations


  • that hospital readmissions are not conducive to the needs of mental health patients for an optimal quality of life in the community, in fact they constitute profound interruptions in a patient’s life
  • that psychiatric hospitalisation carries a stigma which patients understandably want to avoid
  • that hospitalisation may be in itself traumatic and create a post-hospital syndrome of increased risk for all kinds of disorders, the avoidance of rehospitalisation after a hospitalisation for a psychiatric condition can in itself be regarded as an outcome desired by patients, i.e. as a patient centred outcome.

Furthermore, considering

  • that hospital readmissions (if unplanned) are in general not regarded as an indicator of good quality of care and are therefore often used as a metric for hospital performance
  • that the use of hospital facilities is expensive and finding ways of avoiding rehospitalisation would save costs, the topic of identifying factors which are related to hospital readmissions of psychiatric patients was chosen for this comparative effectiveness research project by defining the following overall objective and four specific objectives.

Improve the knowledge base and produce decision support tools

The overall objective of the CEPHOS-LINK project was to improve the knowledge base and producing decision support tools for decision makers in the field of mental health system and services interventions aiming at reducing readmissions and developing seamless continuity of care after hospital discharge.

This was achieved by comparing with a common study protocol psychiatric re-hospitalisation rates in six European countries (Austria, Finland, Italy, Norway Slovenia and Romania) and to identify predictors by regression analyses in a retrospective cohort study design, first locally for each country dataset and then centrally with a pooled dataset.

Spesific objectives

Objective 1
To compare in a registry based observational record linkage study design the rehospitalisation outcome of patients discharged with a primary or secondary psychiatric diagnosis (ICD-10: Chapter V) from hospital treatment in different hospital settings in six European countries.

Objective 2
To compare in a registry based observational record linkage study design the rehospitalisation outcome of patients discharged with a primary or secondary psychiatric diagnosis (ICD-10: Chapter V) from a psychiatric hospital/department in six countries and who had different types of postdischarge interventions and to identify the influence of post-discharge contacts and other specific factors on the patient,service and system level.

Objective 3
To develop a methods toolkit for conducting record linkage studies in the mental health care field in and across European countries, in order to improve the evaluation of mental health care systems in Europe.

Objective 4
To produce recommendations, guidelines and a set of decision support tools for decision makers in the field of mental health system and services intervention related to increasing their understanding of factors that influence rehospitalisation of psychiatric patients.


Lassemo, E., Myklebust, L. H., Salazzari, D., & Kalseth, J. (2021). Psychiatric readmission rates in a multi-level mental health care system–a descriptive population cohort studyBMC Health Services Research21(1), 1-15.

Ådnanes M, Cresswell-Smith J, Melby L, Westerlund H, Šprah L, Sfetcu R, Straßmayr C, Donisi V. Discharge planning, self-management, and community support: strategies to avoid psychiatric rehospitalisation from a service user perspective. Link to an external websiteOpens in a new tabPatient Education and Counseling, 2019, ISSN 0738-3991. 

Katschnig H, Straßmayr C, Endel F, Berger M, Zauner G, Kalseth J, Sfetcu R, Wahlbeck K, Tedeschi F, Šprah L. Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitationsLink to an external websiteOpens in a new tab. Health Policy, 2019.

Ådnanes M, Melby L, Cresswell-Smith J, Westerlund H, Rabbi L, Dernovsek MZ, Sprah L, Sfetcu R,  Stassmayr C, Donisi V. Mental Health Service Users Experiences of Psychiatric Re-hospitalisation - an Explorative Focus Group Study in six European CountriesLink to an external websiteOpens in a new tab. BMC Health Services Research 18:516, 2018.

Kalseth J, Lassemo E, Wahlbeck K, Haaramo P, Magnussen J. Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature (pdf 434 KB).File opens in a new tab PDF 434kB BMC Psychiatry 16:376, 2016. 

Conference Presentations

Policy briefs

Key Factors

Project duration

2014 - 2017


EU Seventh Framework Programme

Cooperation partners

  • The Finnish Institute for Health and Welfare (THL), Finland
  • IMEHPS Research (IMEHPS), Austria
  • National School of Public Health, Management and Professional Development, Bucharest (SNSPMPDSB), Romania
  • SINTEF, Norway
  • The University of Verona (UNIVR), Italy
  • Research Centre of the Slovenian Academy of Sciences and Arts (ZRC SAZU), Slovenia
  • Dwh Gmbh, Austria


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