University of Massachusetts Medical School, Shrewsbury, MA 01545, USA.
Psychiatr Rehabil J. 2011 Summer;35(1):9-19. doi: 10.2975/35.1.2011.9.19.
This study examines the outcomes of a statewide implementation of Intensive Psychiatric Rehabilitation (IPR) for improving residential and employment status and earnings among individuals with severe mental illnesses and also examines its implementation with respect to mental health service utilization and costs.
This study employs a pre-post design with participants acting as their own controls for rehabilitation outcomes (residential status, vocational outcomes and earnings) comparing those who "completed" or had a sufficiently intense dose of IPR (one year) to those who dropped out early (before six months of service) and those who dropped out later in service (6-12 months). A separate analysis was conducted examining the relationship of IPR to other mental service use and costs using a quasi-experimental design that contrasted IPR completers with a control group matched via propensity scores.
The results suggested significant improvement in residential status, employment status and gross monthly earnings for IPR completers relative to other groups. IPR completers also tended to use more mental health services or have more shallow decreases in use and cost of services relative to matched controls.
Gains in rehabilitation outcomes can be expected for those who engage in and complete IPR services, but IPR cannot be expected to result in reduced overall mental health service use and costs. Rather, IPR may improve service access or perhaps ameliorate any containment effect of managed care on service use.
本研究考察了在全州范围内实施强化精神康复（IPR）对改善严重精神疾病患者的居住和就业状况以及收入的结果，并考察了其在精神卫生服务利用和成本方面的实施情况。
本研究采用了一种前后设计，参与者自身作为康复结果（居住状况、职业结果和收入）的对照，将“完成”或接受了足够强度剂量的 IPR（一年）的人与早期（服务前六个月）退出的人以及服务后期（6-12 个月）退出的人进行比较。还进行了一项单独的分析，使用准实验设计，通过倾向评分对 IPR 完成者与对照组进行对比，考察了 IPR 与其他精神服务使用和成本的关系。
结果表明，与其他组相比，IPR 完成者的居住状况、就业状况和每月总收入都有显著改善。与匹配的对照组相比，IPR 完成者也倾向于使用更多的精神卫生服务，或者服务使用和成本的减少幅度较浅。
对于那些参与并完成 IPR 服务的人，可以预期康复结果会有所改善，但不能期望 IPR 会降低整体精神卫生服务的使用和成本。相反，IPR 可能会改善服务的可及性，或者可能会减轻管理式医疗对服务使用的任何遏制效应。
