Mares A, McGuire J
Department of Social Welfare, School of Public Policy and Social Research, University of California, Los Angeles 90095-1656, USA.
Psychiatr Serv. 2000 Jul;51(7):914-21. doi: 10.1176/appi.ps.51.7.914.
The effectiveness of a community-based case management program at the Veterans Affairs West Los Angeles Healthcare Center in reducing hospital readmission of mentally ill veterans living in privately operated board-and-care homes was evaluated.
A retrospective cohort design was used. The sample consisted of 321 patients identified by hospital records as living in one of 24 board-and-care homes in the Los Angeles area that were approved by the community residential care program. A total of 214 subjects who received monthly home visits from case managers (program group) were compared with 107 subjects who did not receive monthly home visits (comparison group). The median number of psychiatric bed-days used was calculated for the two years before and after follow-up. The number of days from the start of follow-up to the first psychiatric hospitalization was also calculated.
Among subjects in the program group, the median number of psychiatric bed-days used decreased significantly, from 59 days to 50 days. No significant change in the median number was observed for comparison subjects. Comparison subjects were rehospitalized 1.7 times more often than program subjects. Overall, program subjects under age 62 (younger subjects) were rehospitalized 2.5 times more often than older subjects. In the program group, those who had received home visits for more than two years were hospitalized three times more often than those who had received visits for less than two years, and younger subjects were rehospitalized 1.8 times more often than older subjects.
The findings suggest that home visits conducted by case managers in a community residential care program helped reduce psychiatric hospitalization among veteran patients living in privately operated board-and-care homes.
评估洛杉矶西区退伍军人事务医疗中心基于社区的病例管理项目在降低居住于私营寄宿护理院的精神病退伍军人再次住院率方面的有效性。
采用回顾性队列设计。样本包括321名患者，这些患者通过医院记录被确定居住在洛杉矶地区24家经社区住宅护理项目批准的寄宿护理院之一。将总共214名接受个案管理员每月家访的受试者（项目组）与107名未接受每月家访的受试者（对照组）进行比较。计算随访前后两年使用的精神科住院天数中位数。还计算了从随访开始到首次精神科住院的天数。
在项目组受试者中，使用的精神科住院天数中位数显著下降，从59天降至50天。对照组受试者的中位数未观察到显著变化。对照组受试者再次住院的频率比项目组受试者高1.7倍。总体而言，62岁以下的项目组受试者（较年轻受试者）再次住院的频率比老年受试者高2.5倍。在项目组中，接受家访超过两年的受试者住院频率是接受家访少于两年的受试者的三倍，较年轻受试者再次住院的频率比老年受试者高1.8倍。
研究结果表明，社区住宅护理项目中的个案管理员进行家访有助于降低居住在私营寄宿护理院的退伍军人患者的精神科住院率。
