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This study measured the time from hospital discharge to first outpatient contact (TDO) within the German healthcare system before and during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Anonymized data of ~\u2009700,000 publicly insured children and adolescents (age: 0.0\u201317.9 years) were retrieved from the InGef database (2018\u20132021). An exploratory analysis examined TDO among patients with documented outpatient contact following discharge, and length of stay (LOS). Analyses were stratified by index diagnosis, sex, age, residency, socioeconomic status, and outpatient specialty. Results were compared pre-COVID-19 (01\/2018\u201303\/2020) vs. intra-COVID-19 (04\/2020\u201312\/2021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between pre-COVID and intra-COVID, TDO decreased significantly for anorexia nervosa (pediatricians: -22.8 days, |d|=0.28; child and adolescent psychotherapists (CAPPs): -33.4 days, |d|=0.35), anxiety disorders (CAPPs: -27.1 days; |d|=0.22), and depressive disorders (child and adolescent psychiatrists: -25 days, |d|=0.22; CAPPs: -23.6 days, |d|=0.21). Reductions in LOS were significant for depressive disorders (-6.8 days, |d|=0.11). Considering the most rapid mean times to any outpatient provider within diagnoses in the pre-COVID period, depressive disorders (\u2248\u200974 days) and anorexia nervosa (\u2248\u200966 days) showed the longest TDO (anxiety disorders\u2009\u2248\u200947 days; obsessive-compulsive disorders\u2009\u2248\u200961 days; post-traumatic stress disorders\u2009\u2248\u200949 days). Regarding sex, residency and socioeconomic status, only minimal differences were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study shows delays (&gt;\u20092 months) between discharge from child and adolescent psychiatric inpatient care and first outpatient contact. Such intervals are noteworthy given the critical need for continuous care in potentially life-threatening conditions like anorexia nervosa, although these intervals shortened during the COVID-19 pandemic. While the underlying mechanisms remain unclear, further investigation is needed to evaluate whether these trends are associated with changes in inter-sectoral transfer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-026-14322-7","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T14:06:30Z","timestamp":1773410790000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuity of care: time to first outpatient appointment after child and adolescent psychiatric hospital stays in Germany"],"prefix":"10.1186","volume":"26","author":[{"given":"Stephan","family":"Zillmer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jule","family":"Leickert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Vivirito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Enders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph U.","family":"Correll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Jaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian J.","family":"Bachmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"14322_CR1","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.genhosppsych.2022.04.004","volume":"77","author":"AJ Millner","year":"2022","unstructured":"Millner AJ, Zuromski KL, Joyce VW, Kelly F, Richards C, Buonopane RJ, et al. 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No individuals, public health insurance companies or health care service providers can be identified. InGef provided the anonymized secondary data required for the project and has the necessary approvals for the use of the data by the participating health insurance funds and the responsible authorities. The study was conducted in accordance with the following national and international guidelines: Good Practice of Secondary Data Analysis, Good epidemiological practice, Guidelines for Good Pharmacoepidemiology Practice, ENCePP-Guidelines for Methodological Standards in Pharmacoepidemiology.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"C.U. Correll has served as consultant\/advisor or received honoraria from AbbVie, Alkermes, Allergan, Angelini, Aristo, Autobahn, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Delpor, Denovo, Draig, Eli Lilly, Eumentis Therapeutics, Gedeon Richter, GH Research, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen\/J&J, Karuna, LB Pharma, Lundbeck, MedInCell, MedLink Global, Merck, Mindpax, Mitsubishi Tanabe Pharmaceuticals, Maplight, Mylan, Neumora Therapeutics, Neuraxpharm, Neurocrine, Neurelis, Neurosterix, NeuShen, Neusignal Therapeutics, Newron, Noven, Novo Nordisk, Orion Pharma, Otsuka, PPD Biotech, Recognify Life Science, Recordati, Relmada, Response Pharmaeutical, Reviva, Rovi, Saladax, Sanofi, Seqirus, Servier, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Tabuk, Takeda, Teva, Terran, Tolmar, Vertex, Viatris and Xenon Pharmaceuticals. He provided expert testimony for Janssen, Lundbeck, Neurocrine, and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, IntraCellular Therapies, Relmada, Reviva, Rovi. He has received grant support from Boehringer-Ingelheim, Janssen and Takeda. He received royalties from UpToDate and is also a stock option or stock holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharmaceuticals, MedLink Global, Mindpax, Quantic, Terran. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"486"}}