Rothbard Aileen B, Lee Sungeun, Culnan Kenneth, Vasko Sandra
Department of Psychiatry, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA 19104, USA.
Psychiatr Serv. 2007 Dec;58(12):1570-6. doi: 10.1176/ps.2007.58.12.1570.
This analysis is a follow-up of a 1992 study of service use and cost of care among patients discharged from a state hospital. This study documented utilization and cost of care in 2002.
Study participants were 150 former long-stay patients who were discharged from a state psychiatric hospital in 1989. An integrated database of all mental health and medical services reimbursed by Medicaid and Medicare as well as state- and county-funded services was used to construct descriptive statistics on service use and unit cost measures. Data on mortality, homelessness and criminal arrests were obtained from vital statistics, jail records and shelter admissions.
During 2002, 18% of study participants had a psychiatric hospital admission, with a mean length of stay of 60 days. Almost all participants (99%) received some form of outpatient mental health care, and 66% were living in publicly funded residential housing. The total annual cost per study participant for the 2002 service package was $89,699. Residential care accounted for 54% of the total cost. Between 1989 and 2005, 3% were admitted to county jails and 9% had experienced homelessness. Of the original discharged sample of 590 patients, 37% died between 1989 and 2002; the mean age at death was 63+/-15 years.
This analysis suggests that individuals discharged from state psychiatric institutions have been integrated into community residential settings and are receiving psychiatric outpatient treatment on a regular basis. Cost estimates, using the consumer price index for 2002, were $78,773 in 1992 compared with $85,850 for the exact same service package in 2002.
本分析是对1992年一项关于从州立医院出院患者的服务利用和护理成本研究的后续研究。本研究记录了2002年的服务利用情况和护理成本。
研究参与者为1989年从州立精神病医院出院的150名 former long - stay患者。使用一个整合了由医疗补助和医疗保险报销的所有心理健康和医疗服务以及州和县资助服务的数据库来构建关于服务利用和单位成本指标的描述性统计数据。关于死亡率、无家可归和刑事逮捕的数据来自人口动态统计、监狱记录和收容所收容情况。
在2002年期间，18%的研究参与者入住了精神病医院，平均住院时长为60天。几乎所有参与者（99%）都接受了某种形式的门诊心理健康护理，66%居住在公共资助的住宅中。2002年每位研究参与者的年度服务套餐总成本为89,699美元。住宿护理占总成本的54%。在1989年至2005年期间，3%的人被送进了县监狱，9%的人经历过无家可归。在最初出院的590名患者样本中，37%在1989年至2002年期间死亡；死亡时的平均年龄为63±15岁。
本分析表明，从州立精神病机构出院的个体已融入社区居住环境，并定期接受精神病门诊治疗。使用2002年消费者价格指数进行的成本估计显示，1992年为78,773美元，而2002年完全相同的服务套餐为85,850美元。
