Smith Thomas E, Stein Bradley D, Donahue Sheila A, Sorbero Mark J, Karpati Adam, Marsik Trish, Myers Robert W, Thomann-Howe Doreen, Appel Anita, Essock Susan M
Dr. Smith and Dr. Essock are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and with the New York State Psychiatric Institute, New York City (e-mail:
Psychiatr Serv. 2014 Nov 1;65(11):1378-80. doi: 10.1176/appi.ps.201300549. Epub 2014 Oct 31.
The study determined rates of reengagement in services for individuals with serious mental illness who had discontinued services.
As part of a quality assurance program in New York City involving continuous review of Medicaid claims and other administrative data, clinician care monitors identified 2,834 individuals with serious mental illness who were apparently in need of care but disengaged from services. The care monitors reviewed monthly updates of Medicaid claims, encouraged outreach from providers who had previously worked with identified individuals, and determined whether individuals had reengaged in services.
Reengagement rates over a 12-month follow-up period were low, particularly for individuals who had been incarcerated or for whom no service provider was available to provide outreach.
Subgroups of disengaged individuals with serious mental illness have different rates of reengagement. Active outreach by providers might benefit some, but such targeting is inefficient when the individual cannot be located.
本研究确定了已停止服务的严重精神疾病患者重新接受服务的比例。
作为纽约市一项质量保证计划的一部分,该计划涉及对医疗补助申请及其他行政数据的持续审查,临床护理监测人员识别出2834名患有严重精神疾病的患者,这些患者显然需要护理但已停止接受服务。护理监测人员审查医疗补助申请的月度更新情况,鼓励曾与已识别患者合作过的服务提供者进行外展服务,并确定患者是否重新接受了服务。
在12个月的随访期内,重新接受服务的比例较低,尤其是对于那些曾被监禁的患者或没有服务提供者可进行外展服务的患者。
患有严重精神疾病且停止接受服务的亚组患者重新接受服务的比例各不相同。服务提供者的积极外展服务可能会使一些患者受益,但当无法找到患者时,这种针对性的服务效率低下。