解释社区心理健康中心优先次序设定的因素：转诊评估的定量分析。

Factors explaining priority setting at community mental health centres: a quantitative analysis of referral assessments.

作者信息

Grepperud Sverre, Holman Per Arne, Wangen Knut Reidar

机构信息

Department of Health Management and Health Economics, University of Oslo, PO 1089, N-0317, Oslo, Norway.

Lovisenberg Diakonale Hospital, N-0440, Oslo, Norway.

出版信息

BMC Health Serv Res. 2014 Dec 14;14:620. doi: 10.1186/s12913-014-0620-3.

DOI:10.1186/s12913-014-0620-3

PMID:25496562

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4272526/

Abstract

BACKGROUND

Clinicians at Norwegian community mental health centres assess referrals from general practitioners and classify them into three priority groups (high priority, low priority, and refusal) according to need where need is defined by three prioritization criteria (severity, effect, and cost-effectiveness). In this study, we seek to operationalize the three criteria and analyze to what extent they have an effect on clinical-level priority setting after controlling for clinician characteristics and organisational factors.

METHODS

Twenty anonymous referrals were rated by 42 admission team members employed at 14 community mental health centres in the South-East Health Region of Norway. Intra-class correlation coefficients were calculated and logistic regressions were performed.

RESULTS

Variation in clinicians' assessments of the three criteria was highest for effect and cost-effectiveness. An ordered logistic regression model showed that all three criteria for prioritization, three clinician characteristics (education, being a manager or not, and "guideline awareness"), and the centres themselves (fixed effects), explained priority decisions. The relative importance of the explanatory factors, however, depended on the priority decision studied. For the classification of all admitted patients into high- and low-priority groups, all clinician characteristics became insignificant. For the classification of patients, into those admitted and non-admitted, one criterion (effect) and "being a manager or not" became insignificant, while profession ("being a psychiatrist") became significant.

CONCLUSIONS

Our findings suggest that variation in priority decisions can be reduced by: (i) reducing the disagreement in clinicians' assessments of cost-effectiveness and effect, and (ii) restricting priority decisions to clinicians with a similar background (education, being a manager or not, and "guideline awareness").

摘要

背景

挪威社区心理健康中心的临床医生对来自全科医生的转诊进行评估，并根据需求将其分为三个优先级组（高优先级、低优先级和拒绝），其中需求由三个优先级标准（严重程度、影响和成本效益）定义。在本研究中，我们试图将这三个标准操作化，并分析在控制临床医生特征和组织因素后，它们在多大程度上对临床层面的优先级设定产生影响。

方法

挪威东南部健康区域的14个社区心理健康中心的42名入院团队成员对20份匿名转诊进行了评分。计算了组内相关系数并进行了逻辑回归分析。

结果

临床医生对三个标准的评估差异在影响和成本效益方面最大。有序逻辑回归模型表明，所有三个优先级标准、三个临床医生特征（教育程度、是否为管理人员以及“指南意识”）以及中心本身（固定效应）都可以解释优先级决策。然而，解释因素的相对重要性取决于所研究的优先级决策。对于将所有入院患者分为高优先级和低优先级组，所有临床医生特征都变得不显著。对于将患者分为入院和未入院两组，一个标准（影响）和“是否为管理人员”变得不显著，而职业（“是否为精神科医生”）变得显著。