Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, and San Francisco U.S. Department of Veterans Affairs (VA) Health Care, San Francisco (Ruderman, Byers); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston (Bauer, Stolzmann, Miller, Connolly, Kim); Department of Psychiatry, Harvard Medical School, Boston (Bauer, Miller, Connolly, Kim).
Psychiatr Serv. 2023 Oct 1;74(10):1077-1080. doi: 10.1176/appi.ps.20220428. Epub 2023 Apr 5.
This study aimed to determine whether the evidence-based collaborative chronic care model (CCM) is associated with reduced all-cause mortality among adult patients treated in general mental health clinics.
Data came from a stepped-wedge, cluster-randomized CCM implementation trial across nine U.S. Department of Veterans Affairs medical centers. Survival analysis was used to estimate the relative effect of the treatment (N=5,570) compared with a control group (N=46,443) over 1 year.
After adjustment for site-level and individual-level acute care utilization factors, analyses indicated that patients treated with the CCM experienced a reduction in all-cause mortality relative to patients in the control cohort (hazard ratio=0.76, 95% CI=0.60-0.95).
This study is the first in which CCM has been shown to reduce all-cause mortality for patients treated in general mental health clinics. Care delivery models should be considered part of efforts to reduce the life expectancy gap between individuals with psychiatric conditions and those without such conditions.
本研究旨在确定基于循证的协作式慢性病管理模式(CCM)是否与接受普通精神健康诊所治疗的成年患者全因死亡率降低相关。
数据来自美国退伍军人事务部 9 家医疗中心的一项递进式、群组随机 CCM 实施试验。生存分析用于估计治疗组(N=5570)与对照组(N=46443)在 1 年内的相对效果。
在调整了站点水平和个体水平急性护理利用因素后,分析表明,与对照组相比,接受 CCM 治疗的患者全因死亡率降低(风险比=0.76,95%CI=0.60-0.95)。
这是第一项表明 CCM 可降低普通精神健康诊所治疗患者全因死亡率的研究。应该将护理提供模式视为缩小有和无精神疾病个体之间预期寿命差距努力的一部分。