McKay J R, McLellan A T, Alterman A I
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia.
Am J Psychiatry. 1992 Sep;149(9):1212-8. doi: 10.1176/ajp.149.9.1212.
This study examined the validity of the Cleveland Admission, Discharge, and Transfer Criteria, a comprehensive system for assigning alcohol- and drug-abusing patients to appropriate levels of care.
The subjects were 143 alcoholic and cocaine-dependent male patients in an intensive Veterans Administration day treatment program for substance abusers. Patients who should have received inpatient treatment according to the Cleveland criteria were compared with those who were properly "matched" to day treatment according to the criteria. The outcome measures were treatment completion, results of urine toxicology screens, and self-reports of substance use and psychosocial functioning.
Patients who met the criteria for inpatient care were not more likely to drop out of day hospital treatment, and there was no evidence that they were drinking or using cocaine more frequently during follow-up. Furthermore, they did not appear to be doing worse on any of the other outcome measures, with the exception of psychological status.
The results suggest that for male substance abusers in the lower socioeconomic levels, the Cleveland criteria may not be effective in differentiating patients who can manage well with day hospital treatment and those who require inpatient treatment.
本研究检验了克利夫兰入院、出院及转院标准的有效性，该标准是一个将酗酒和药物滥用患者分配至适当护理级别的综合系统。
研究对象为143名患有酒精和可卡因依赖的男性患者，他们参加了退伍军人管理局针对药物滥用者的强化日间治疗项目。将根据克利夫兰标准应接受住院治疗的患者与根据该标准被恰当“匹配”至日间治疗的患者进行比较。结果指标包括治疗完成情况、尿液毒理学筛查结果以及药物使用和心理社会功能的自我报告。
符合住院护理标准的患者退出日间医院治疗的可能性并不更高，且没有证据表明他们在随访期间饮酒或使用可卡因更频繁。此外，除心理状态外，他们在其他任何结果指标上似乎都没有表现得更差。
结果表明，对于社会经济水平较低的男性药物滥用者，克利夫兰标准可能无法有效区分能够通过日间医院治疗良好管理的患者和需要住院治疗的患者。
