Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich.
Psychiatr Serv. 2017 Sep 1;68(9):970-974. doi: 10.1176/appi.ps.201600114. Epub 2017 May 15.
The study explored relationships between preferences for and experiences of clinical decision making (CDM) with service use among persons with severe mental illness.
Data from a prospective observational study in six European countries were examined. Associations of baseline staff-rated (N=213) and patient-rated (N=588) preferred and experienced decision making with service use were examined at baseline by using binomial regressions and at 12-month follow-up by using multilevel models.
A preference by patients and staff for active patient involvement in decision making, rather than shared or passive decision making, was associated with longer hospital admissions and higher costs at baseline and with increases in admissions over 12 months (p=.043). Low patient-rated satisfaction with an experienced clinical decision was also related to increased costs over the study period (p=.005).
A preference for shared decision making may reduce health care costs by reducing inpatient admissions. Patient satisfaction with decisions was a predictor of costs, and clinicians should maximize patient satisfaction with CDM.
本研究探讨了严重精神疾病患者对临床决策（CDM）的偏好和体验与服务利用之间的关系。
对来自六个欧洲国家的前瞻性观察性研究的数据进行了检查。基线时，使用二项式回归检查了基线时工作人员（N=213）和患者（N=588）评定的偏好和体验决策与服务利用之间的关联，并在 12 个月随访时使用多层模型进行了检查。
患者和工作人员偏爱积极参与决策，而不是共享或被动决策，这与基线时的住院时间延长和费用增加以及 12 个月内的住院人数增加有关（p=.043）。患者对临床决策体验的低满意度也与研究期间费用的增加有关（p=.005）。
共享决策的偏好可能通过减少住院人数来降低医疗保健成本。患者对决策的满意度是成本的预测因素，临床医生应最大限度地提高患者对 CDM 的满意度。
