英格兰标准急性住院治疗的替代方案：短期临床结果与成本效益

Alternatives to standard acute in-patient care in England: short-term clinical outcomes and cost-effectiveness.

作者信息

Slade M, Byford S, Barrett B, Lloyd-Evans B, Gilburt H, Osborn D P J, Skinner R, Leese M, Thornicroft G, Johnson S

机构信息

Health Service and Population Research Department, Box PO29, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.

出版信息

Br J Psychiatry Suppl. 2010 Aug;53:s14-9. doi: 10.1192/bjp.bp.110.081059.

DOI:10.1192/bjp.bp.110.081059

PMID:20679274

Abstract

BACKGROUND

Outcomes following admission to residential alternatives to standard in-patient mental health services are underresearched.

AIMS

To explore short-term outcomes and costs of admission to alternative and standard services.

METHOD

Health of the Nation Outcome Scales (HoNOS), Threshold Assessment Grid (TAG), Global Assessment of Functioning (GAF) and admission cost data were collected for six alternative services and six standard services.

RESULTS

All outcomes improved during admission for both types of service (n = 433). Adjusted improvement was greater for standard services in scores on HoNOS (difference 1.99, 95% CI 1.12-2.86), TAG (difference 1.40, 95% CI 0.39-2.51) and GAF functioning (difference 4.15, 95% CI 1.08-7.22) but not GAF symptoms. Admissions to alternatives were 20.6 days shorter, and hence cheaper (UK pound3832 v. pound9850). Standard services cost an additional pound2939 per unit HoNOS improvement.

CONCLUSIONS

The absence of clear-cut advantage for either type of service highlights the importance of the subjective experience and longer-term costs.

摘要

背景

相较于标准的住院心理健康服务，入住替代性住宿服务后的结果研究较少。

目的

探讨入住替代性服务和标准服务的短期结果及成本。

方法

收集了六项替代性服务和六项标准服务的《国家健康结果量表》（HoNOS）、阈值评估网格（TAG）、功能总体评估（GAF）以及住院成本数据。

结果

两类服务在住院期间所有结果均有改善（n = 433）。在HoNOS评分（差异1.99，95%可信区间1.12 - 2.86）、TAG评分（差异1.40，95%可信区间0.39 - 2.51）和GAF功能评分（差异4.15，95%可信区间1.08 - 7.22）方面，标准服务的调整后改善更大，但GAF症状评分并非如此。入住替代性服务的住院时间短20.6天，因此成本更低（3832英镑对9850英镑）。标准服务每改善一个单位的HoNOS评分，额外成本为2939英镑。