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评估心理健康危机中成人急诊科的替代方案。

Evaluating an Alternative to the Emergency Department for Adults in Mental Health Crisis.

作者信息

Heyland Michelle, Johnson Mary

机构信息

a College of Nursing , Rush University , Chicago , Illinois , USA.

出版信息

Issues Ment Health Nurs. 2017 Jul;38(7):557-561. doi: 10.1080/01612840.2017.1300841. Epub 2017 Apr 7.

Abstract

Adults with mental health issues lack clinically indicated options when in crisis. Historically, the emergency department (ED) has been the primary source of intervention largely due to funding cuts and decreased community resources in the USA. The literature highlights drastic mental health funding cuts alongside an increased prevalence of mental illness. A community-based alternative for adults in mental health crises was subsequently developed as a model of crisis care. The program has demonstrated impressive short-term outcomes, typically avoiding ED admissions in over 95% of the clients. This number benefits both the consumers who otherwise rely on the ED and the State of Illinois in terms of cost savings for avoidable ED visits. The current deflection rate only reflects ED admissions deflected on the day of the visit to the crisis respite program. To establish the long-term outcomes for this model, follow-up phone calls were conducted to determine whether or not the individual required an ED visit for a psychiatric reason within 30 days of utilization of the program. The follow-up phone calls began in May and continued for eight weeks. At this time, the data collected were analyzed and the outcomes of the program were further evaluated. Based on the follow-up survey results, the positive long-term outcomes validate this model as a cost-saving and clinically indicated alternative to the ED. Establishing such outcomes was necessary to ensure continued funding and to support establishment of similar models of crisis care.

摘要

有心理健康问题的成年人在危机时刻缺乏临床推荐的选择。从历史上看,在美国,由于资金削减和社区资源减少,急诊科一直是主要的干预来源。文献强调了心理健康资金的大幅削减以及精神疾病患病率的上升。随后,一种针对心理健康危机成年人的社区替代方案作为危机护理模式得以开发。该项目已展现出令人印象深刻的短期成果,通常能避免超过95%的客户进入急诊科就诊。这一数字对那些原本依赖急诊科的消费者以及伊利诺伊州来说都有益处,因为可避免的急诊科就诊节省了成本。目前的转移率仅反映了在前往危机缓解项目当天被转移的急诊科就诊人数。为了确定该模式的长期效果,进行了随访电话,以确定个人在使用该项目后的30天内是否因精神科原因需要前往急诊科就诊。随访电话于5月开始,持续了八周。此时,对收集到的数据进行了分析,并对该项目的结果进行了进一步评估。根据随访调查结果,积极的长期成果证实了该模式是一种节省成本且有临床依据的急诊科替代方案。确定这样的结果对于确保持续的资金支持以及支持建立类似的危机护理模式是必要的。

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