美国养老院精神卫生服务提供情况，1995-2004 年。
Provision of mental health services in U.S. nursing homes, 1995-2004.
机构信息
Division of General Internal Medicine, University of Iowa, SE610 GH, 200 Hawkins Dr., Iowa City, IA 52242, USA.
出版信息
Psychiatr Serv. 2010 Apr;61(4):349-55. doi: 10.1176/ps.2010.61.4.349.
OBJECTIVE
This study tracked the ability of U.S. nursing homes to provide on-site mental health services after the Omnibus Budget Reconciliation Act (OBRA) of 1987 mandated the detection and treatment of mental illness among nursing home patients. The study also determined cross-sectional correlates of service availability and models of services.
METHODS
Retrospective analyses were done using National Nursing Home Surveys from 1995, 1997, 1999, and 2004 (the most recent survey). The surveys are periodically conducted by the Centers for Disease Control and Prevention and represent the nation's approximately 17,000 nursing homes. The longitudinal trend of mental health service provision was analyzed for all facilities and for subgroups of facilities. Multivariate regression determined facility and geographic correlates in 2004.
RESULTS
Roughly 80% of facilities provided on-site mental health services each survey year. In 2004, 25% of facilities provided mental health services regularly or at routinely scheduled times (regular basis), 24% provided them in an on-call manner (or as needed), and 28% provided them on both a regular and on-call basis. The remaining 22% of facilities provided no on-site mental health services. Multivariate analyses found that largest facilities (> or = 200 beds) were more able than small facilities (< 100 beds) to serve persons with mental illness (odds ratio=3.80, p=.024); compared with their counterparts, facilities were more likely to provide on-site services if they had a larger proportion of residents covered by Medicare or Medicaid programs, were in the Northeast region, or were in metropolitan areas. Similar correlates were found when the types of service provision models (regular basis, on-call basis, both a regular and on-call basis) were examined.
CONCLUSIONS
The overall availability of nursing home-based mental health services did not improve over time during the post-OBRA era. Service availability is more problematic for certain facilities, such as small or rural ones. Financial, regulatory, and system-level efforts are needed to address this issue.
目的
本研究跟踪了 1987 年《综合预算协调法案》（OBRA）要求在护理院患者中发现和治疗精神疾病后，美国护理院提供现场精神卫生服务的能力。该研究还确定了服务提供的横断面相关性和服务模式。
方法
使用疾病控制和预防中心定期进行的 1995 年、1997 年、1999 年和 2004 年（最新调查）国家护理院调查进行回顾性分析。该调查代表了全国约 17000 家养老院。分析了所有设施和设施分组的精神卫生服务提供的纵向趋势。多元回归确定了 2004 年设施和地理相关性。
结果
大约 80%的设施在每个调查年度都提供现场精神卫生服务。在 2004 年，25%的设施定期或定期安排时间（定期）提供精神卫生服务，24%按需要提供服务（按需），28%定期和按需提供服务。其余 22%的设施没有提供现场精神卫生服务。多元分析发现，最大的设施（>或=200 张床）比小设施（<100 张床）更有能力为精神疾病患者服务（优势比=3.80，p=.024）；与他们的同行相比，如果设施有更大比例的居民覆盖医疗保险或医疗补助计划、位于东北地区或大都市区，则更有可能提供现场服务。在检查提供服务的模式类型（定期基础、按需基础、定期和按需基础）时，也发现了类似的相关性。
结论
在 OBRA 之后的时代，护理院精神卫生服务的整体可用性并没有随着时间的推移而提高。某些设施（如小型或农村设施）的服务可用性存在更多问题。需要在财务、监管和系统层面做出努力来解决这个问题。
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