Hedrick S C, Rothman M L, Chapko M, Inui T S, Kelly J R, Ehreth J
HSR&D Field Program, VA Medical Center, Seattle, WA 98108.
Health Serv Res. 1991 Feb;25(6):935-60.
The Adult Day Health Care Evaluation Study was developed in response to a congressional mandate to study the medical efficacy and cost effectiveness of the Adult Day Health Care (ADHC) effort in the Department of Veterans Affairs (VA). Four sites providing ADHC in VA facilities are participating in an ongoing randomized controlled trial. Three years of developmental work prior to the study addressed methodological issues that were problematic in previous studies. This developmental work resulted in the methodological approaches described here: (1) a patient recruitment process that actively recruits and screens all potential candidates using empirically developed admission criteria based on predictors of nursing home placement in VA; (2) the selection and development of measures of medical efficacy that assess a wide range of patient and caregiver outcomes with sufficient sensitivity to detect small but clinically important changes; and (3) methods for detailed, accurate, and efficient measurement of utilization and costs of health care within and outside VA. These approaches may be helpful to other researchers and may advance the methodological sophistication of long-term care program evaluation.
成人日托保健评估研究是应国会要求而开展的，旨在研究退伍军人事务部（VA）的成人日托保健（ADHC）工作的医学疗效和成本效益。VA设施中提供ADHC服务的四个地点正在参与一项正在进行的随机对照试验。在该研究之前的三年开发工作解决了以往研究中存在问题的方法学问题。这项开发工作产生了此处所述的方法学方法：（1）患者招募过程，该过程使用基于VA疗养院安置预测因素的经验性制定的入院标准，积极招募和筛选所有潜在候选人；（2）医学疗效测量指标的选择和开发，这些指标以足够的敏感性评估广泛的患者和护理人员结果，以检测微小但具有临床重要性的变化；（3）详细、准确和高效地测量VA内外医疗保健利用情况和成本的方法。这些方法可能对其他研究人员有所帮助，并可能提高长期护理项目评估的方法学复杂性。
