Foster E M
School of Policy Studies, Applied Research Center, Georgia State University, Atlanta 30302-4039, USA.
Health Serv Res. 1999 Aug;34(3):715-36.
To determine whether aftercare services reduce the likelihood that children and adolescents will be readmitted to inpatient psychiatric facilities.
DATA SOURCES/STUDY SETTING: Analyses of data from the Fort Bragg Demonstration. Data were based on 204 sample individuals (children and adolescents), all of whom were discharged from inpatient facilities during the study period.
These analyses use hazard modeling to examine the impact of aftercare services on the likelihood of readmission. Comparisons of individuals for whom the timing of aftercare services differ are adjusted for a wide range of individual characteristics, including client demographics, diagnosis, symptomatology, and psychosocial functioning.
DATA COLLECTION/EXTRACTION METHODS: Detailed data on psychopathology, symptomatology, and psychosocial functioning were collected on individuals included in these analyses. This information was taken from structured diagnostic interviews and behavior checklists, including the Child Behavior Checklist and Diagnostic Interview Schedule for Children, completed by the child and his or her caretaker. Information on the use of mental health services was taken from insurance claims and a management information system, and was used to identify the period from discharge to readmission and to describe the client's use of outpatient therapy, case management, intermediate (or stepdown) services, and residential treatment centers during this period.
PRINCIPAL FINDINGS/CONCLUSIONS: Using Cox models that allow for censoring and that include the use of aftercare services as time-varying covariates, we find that aftercare services generally do not influence the likelihood of inpatient readmission. For the lower middle class families included in this study, the estimated effect of aftercare is not statistically significant and has limited practical significance. When we look at specific forms of aftercare, we find that outpatient therapy has the largest effect and that stepdown services in intermediate settings have the smallest. We also identify family and individual characteristics that influence the likelihood of readmission.
确定出院后护理服务是否会降低儿童和青少年再次入住住院精神科设施的可能性。
数据来源/研究背景：对布拉格堡示范项目的数据进行分析。数据基于204名样本个体（儿童和青少年），他们均在研究期间从住院设施出院。
这些分析使用风险模型来检验出院后护理服务对再次入院可能性的影响。对出院后护理服务时间不同的个体进行比较时，针对广泛的个体特征进行了调整，包括客户人口统计学特征、诊断、症状学和心理社会功能。
数据收集/提取方法：收集了纳入这些分析的个体的详细心理病理学、症状学和心理社会功能数据。这些信息来自结构化诊断访谈和行为清单，包括由儿童及其照顾者完成的儿童行为清单和儿童诊断访谈表。关于心理健康服务使用情况的信息来自保险理赔和管理信息系统，用于确定出院至再次入院的时间段，并描述客户在此期间对门诊治疗、病例管理、中级（或逐步降级）服务和住院治疗中心的使用情况。
主要发现/结论：使用允许删失并将出院后护理服务的使用作为时变协变量的Cox模型，我们发现出院后护理服务通常不会影响再次入住住院设施的可能性。对于本研究中纳入的中下层阶级家庭，出院后护理的估计效果在统计学上不显著，实际意义有限。当我们查看出院后护理的具体形式时，我们发现门诊治疗的效果最大，中级环境中的逐步降级服务效果最小。我们还确定了影响再次入院可能性的家庭和个体特征。
