Cecil G. Sheps Center for Health Services Research, University of North Carolina (UNC), Chapel Hill. Dr. Cuddeback is also with the School of Social Work, UNC, 325 Pittsboro St., CB#3550, Chapel Hill, NC 27599, USA.
Psychiatr Serv. 2013 Apr 1;64(4):318-23. doi: 10.1176/appi.ps.201200097.
A previous study of a recovery-oriented assertive community treatment initiative (PACT) in Washington State found reductions in state psychiatric hospital use and related costs for PACT participants, especially in the first six months after enrollment and for consumers who were high users of the state psychiatric hospital before ACT enrollment. This study examined whether these outcomes varied by team fidelity to recovery-oriented ACT practices.
Generalized estimating equations (GEE) were used to examine the relationship between scores on the Tool for Measurement of Assertive Community Treatment (TMACT), a recently developed tool for assessing fidelity to recovery-oriented ACT, and the use of state hospitals, local hospitals, emergency departments, local crisis stabilization units, and arrests for 631 PACT consumers. These relationships were also examined for PACT consumers with any state hospital use (N=450) and those considered high users of the state hospital (≥ 96 days in two years before PACT enrollment).
TMACT scores were associated (p<.01) with a decrease in the amount of use but not the probability of using state psychiatric hospitals, local hospital psychiatric inpatient units, and local crisis stabilization units. The marginal effects of higher TMACT scores on the probability and use of emergency departments or arrests were not statistically significant.
This study provides preliminary evidence for the predictive validity of the TMACT. Future research should examine the subscale structure of the TMACT as well as the association between TMACT fidelity and consumer well-being, quality of life, and other important person-centered outcomes.
先前对华盛顿州以康复为导向的积极社区治疗计划（PACT）的研究发现，PACT 参与者的州立精神病院使用量和相关费用有所减少，特别是在入组后的头六个月，以及在 ACT 入组前曾大量使用州立精神病院的消费者中。本研究探讨了这些结果是否因团队对康复导向的 ACT 实践的忠诚度而有所不同。
使用广义估计方程（GEE）来检验工具评估积极社区治疗的测量（TMACT）的得分与州立医院、当地医院、急诊部、当地危机稳定单位和 631 名 PACT 消费者的逮捕之间的关系。还对任何州立医院使用的 PACT 消费者（N=450）和被认为是州立医院高使用者（≥2 年内 96 天）进行了这些关系的检验。
TMACT 得分与使用量的减少相关（p<.01），但与使用州立精神病院、当地医院精神病住院部和当地危机稳定单位的概率无关。较高 TMACT 得分对急诊部或逮捕的概率和使用的边际效应在统计学上并不显著。
本研究为 TMACT 的预测效度提供了初步证据。未来的研究应该检验 TMACT 的子量表结构，以及 TMACT 保真度与消费者的幸福感、生活质量和其他重要的以人为主导的结果之间的关联。
