Rössler W, Löffler W, Fätkenheuer B, Riecher-Rössler A
Central Institute of Mental Health, Mannheim, Germany.
Acta Psychiatr Scand. 1992 Dec;86(6):445-9. doi: 10.1111/j.1600-0447.1992.tb03295.x.
It was expected from deinstitutionalization that outpatient care could replace hospital care. But many empirical studies proved that the number of admissions to psychiatric hospitals rose when community-based care developed. This might be due to the lack of coordination and cooperation of extramural services. The concept of case management therefore originated in the last few years. In this study the effect of case management on the rehospitalization rate is examined by analyzing the data of 4 social-psychiatric services responsible for defined catchment areas. During the evaluation period of 2.5 years, 162 patients dismissed from psychiatric hospitals were referred to those services. For each of these index patients a matched control patient was identified, each identical in diagnosis, sex, age, living conditions and number of previous inpatient episodes. The results of a survival analysis show that there are no significant effects of case management on the rate of rehospitalization nor on the length of time in hospital in case of a rehospitalization.
人们曾期望非机构化能使门诊护理取代住院护理。但许多实证研究证明，随着社区护理的发展，精神病医院的住院人数却增加了。这可能是由于院外服务缺乏协调与合作。因此，病例管理的概念在过去几年中应运而生。在本研究中，通过分析负责特定集水区的4个社会精神病服务机构的数据，考察了病例管理对再住院率的影响。在2.5年的评估期内，162名从精神病医院出院的患者被转介到这些服务机构。对于每一位这些索引患者，都确定了一名匹配的对照患者，在诊断、性别、年龄、生活条件和既往住院次数方面均相同。生存分析结果表明，病例管理对再住院率以及再住院情况下的住院时间长度均无显著影响。
