Tucker Sue, Hughes Jane, Jolley David, Buck Deborah, Hargreaves Claire, Challis David
Research Fellow, Personal Social Services Research Unit, University of Manchester, UK.
Senior Research Fellow, Personal Social Services Research Unit, University of Manchester, UK.
BJPsych Open. 2018 Oct 15;4(6):420-426. doi: 10.1192/bjo.2018.60. eCollection 2018 Nov.
Research suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.
To identify which individuals require what services, at what cost.
A 'balance of care' (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.
Community care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.
The findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.
None.
研究表明，如果能提供强化服务，相当一部分住院患者在社区中可能会得到更合适的支持。然而，对于这些患者个体以及他们所需的服务，我们知之甚少。
确定哪些个体需要何种服务以及成本多少。
在英格兰北部开展了一项“护理平衡”（BoC）研究。利用关于315例入院病例的常规电子数据，这些病例被分类为不同患者群体，一线从业者采用改良的名义小组方法，确定了那些需求可在替代环境中得到满足的患者，并明确了他们所需的服务。成本核算采用公共部门方法。
约四分之一的入院患者被认为适合社区护理，包括患有轻中度抑郁症、饮食失调或人格障碍的患者，以及一些精神分裂症患者。提议的社区替代方案严重依赖护理人员支持服务、社区心理健康团队和顾问，并且对于增加非工作时间的社区服务存在广泛共识。与住院治疗相比，提议的社区护理成本相对较低。平均而言，社会护理成本每周增加约60英镑，但总成本每周下降1626英镑。
这些发现为国家政策制定者和地方服务规划者都提出了战略问题。可以在家中得到管理的患者可以通过诊断来描述。虽然确定了潜在的资金节省，但报告的成本差异并不直接等同于成本节省。尚不清楚是否可以减少住院床位。然而，现有的床位可以得到更有效的利用。
无。
