Herz M I
Int J Partial Hosp. 1985 Jun;3(2):81-90.
Under new cost-containment regulations such as diagnostically related groups (DRGs) and capitation-based programs such as health maintenance organizations (HMOs), it will be advantageous to employ treatment strategies which reduce the utilization of hospitalization for acute psychiatric episodes. Results of clinical research studies have demonstrated that if a comprehensive system of mental-health care delivery is employed, alternatives to hospitalization can be less costly and often more effective clinically. Examples of alternative ambulatory treatment strategies include vigorous treatment of prodromal symptoms to prevent full relapse from occurring, family crisis therapy, home care, and day hospitalization. If hospitalization cannot be avoided, brief hospitalization is often at least as effective clinically as standard hospitalization and is certainly less expensive. As the impact of prospective payment plans increases, it is predicted that there will be a shift away from the central role of hospitalization in the treatment of acute psychiatric disorders.
在诸如诊断相关分组（DRGs）等新的成本控制法规以及诸如健康维护组织（HMOs）等基于人头付费的项目下，采用能够减少急性精神疾病发作住院率的治疗策略将具有优势。临床研究结果表明，如果采用全面的心理健康护理提供系统，住院替代方案在成本上可能更低，而且在临床上往往更有效。替代门诊治疗策略的例子包括对前驱症状进行积极治疗以防止完全复发、家庭危机治疗、家庭护理和日间住院治疗。如果无法避免住院，短期住院在临床上通常至少与标准住院一样有效，而且成本肯定更低。随着前瞻性支付计划的影响增加，预计在急性精神疾病治疗中，住院的核心地位将发生转变。
