Unit for Social and Community Psychiatry, Queen Mary University of London, Barts and London School of Medicine, London, UK.
Psychiatr Serv. 2011 Mar;62(3):278-84. doi: 10.1176/ps.62.3.pss6203_0278.
The study aimed to identify patient characteristics associated with differences in outcomes of acute treatment in day hospitals and conventional hospital wards.
Data were from the European Day Hospital Evaluation (EDEN) (2000-2003), a multicenter randomized controlled trial comparing acute treatment in day hospitals and conventional wards in five European countries. All 880 adult patients in the EDEN study who had a diagnosis of schizophrenia, mood disorders, neurotic disorders, and behavioral syndromes (ICD-10 codes F20-F59) and complete data on baseline variables were included. Outcomes were symptom levels (Brief Psychiatric Rating Scale), subjective quality of life (Manchester Short Assessment of Quality of Life), and social disability (Groningen Social Disabilities Schedule) assessed at discharge and at three and 12 months postdischarge. Mixed- and main-effects models of interaction effects between patient characteristics and outcomes were generated.
Patients' age, diagnostic category, and living status (alone or not) did not predict differences in outcomes between the two settings. However, patients with higher symptom levels at baseline experienced greater symptom improvements after treatment on a ward, and those with more years of education had greater symptom improvements after day hospital treatment. Female patients had more favorable social disability outcomes after day hospital treatment, but no difference between the two settings was found for male patients.
More severe symptoms may be a reason for admission to acute treatment on a conventional ward rather than a day hospital. Female patients and those with more education may benefit more from acute treatment in day hospitals.
本研究旨在确定与日间医院和传统病房急性治疗结果差异相关的患者特征。
数据来自欧洲日间医院评估（EDEN）（2000-2003 年），这是一项多中心随机对照试验，比较了在五个欧洲国家的日间医院和传统病房进行的急性治疗。EDEN 研究中所有 880 名患有精神分裂症、心境障碍、神经症和行为综合征（ICD-10 编码 F20-F59）且基线变量完整数据的成年患者均被纳入研究。出院时以及出院后 3 个月和 12 个月评估的结果包括症状水平（简明精神病评定量表）、主观生活质量（曼彻斯特简短评估生活质量）和社会残疾（格罗宁根社会残疾量表）。生成了患者特征与结局之间交互作用的混合效应和主效应模型。
患者的年龄、诊断类别和居住状况（单独或不单独）并不能预测两种治疗环境下结局的差异。然而，基线时症状水平较高的患者在病房接受治疗后症状改善更大，而受教育年限较长的患者在日间医院接受治疗后症状改善更大。女性患者在日间医院治疗后社会残疾结局更好，但男性患者在两种治疗环境下无差异。
更严重的症状可能是入住传统病房进行急性治疗而不是日间医院治疗的原因。女性患者和受教育程度较高的患者可能从日间医院的急性治疗中获益更多。
