医疗补助保险的严重精神疾病患者过渡性护理的改善
Improvements in Transitional Care Among Medicaid-Insured Patients With Serious Mental Illness.
作者信息
Nikpour Jacqueline, Langston Christine, Brom Heather, Sliwinski Kathy, Mason Aleigha, Garcia Dianne, Grantham-Murillo Marsha, Bennett Jovan, Cacchione Pamela Z, Brooks Carthon J Margo
机构信息
Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Nikpour); Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Hillman Scholars in Nursing Innovation, University of Pennsylvania, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Ms Langston); Department of Biobehavioral Health Sciences and Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Brom); Integrated Fellowship in Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Sliwinski); School of Nursing, Columbia University, New York, New York (Dr Mason); University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (Ms Garcia); Penn Medicine at Home, Philadelphia, Pennsylvania (Ms Grantham-Murillo); Penn Center for Community Health Workers, Philadelphia, Pennsylvania (Mr Bennett); Department of Family & Community Health, Gerontological Nursing, and Penn Presbyterian Medical Center, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (Dr Cacchione); and Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Brooks Carthon).
出版信息
J Nurs Care Qual. 2025;40(1):76-83. doi: 10.1097/NCQ.0000000000000805. Epub 2024 Sep 30.
BACKGROUND
The Thrive program is an evidenced-based care model for Medicaid-insured adults in the hospital-to-home transition. A substantial portion of Thrive participants live with serious mental illness (SMI), yet Thrive's efficacy has not been tested among these patients.
PURPOSE
To compare 30-day postdischarge outcomes between Thrive participants with and without SMI and explore Thrive's appropriateness and acceptability among participants with SMI.
METHODS
We conducted a sequential explanatory mixed-methods study of 252 (62 with SMI) Thrive participants discharged from an academic medical center from February 2021 to August 2023. Interviews of participants with SMI were analyzed using rapid qualitative analysis.
RESULTS
Participants with and without SMI experienced similar rates of 30-day readmissions, emergency room visits, and postdischarge follow-up visits, with these differences being nonsignificant. Participants with SMI were highly satisfied with Thrive's care coordination and attention to social needs, yet participants suggested stronger connections to behavioral health care.
CONCLUSIONS
Participants with and without SMI benefit equitably from Thrive.
背景
“茁壮成长”项目是一种针对从医院过渡到家庭阶段的医疗补助参保成年人的循证护理模式。“茁壮成长”项目的很大一部分参与者患有严重精神疾病（SMI），然而该项目在这些患者中的疗效尚未得到检验。
目的
比较有和没有严重精神疾病的“茁壮成长”项目参与者出院后30天的结局，并探讨该项目在患有严重精神疾病的参与者中的适宜性和可接受性。
方法
我们对2021年2月至2023年8月从一家学术医疗中心出院的252名（62名患有严重精神疾病）“茁壮成长”项目参与者进行了一项序贯解释性混合方法研究。使用快速定性分析对患有严重精神疾病的参与者的访谈进行了分析。
结果
有和没有严重精神疾病的参与者30天再入院率、急诊室就诊率和出院后随访率相似，这些差异无统计学意义。患有严重精神疾病的参与者对“茁壮成长”项目的护理协调和对社会需求的关注高度满意，但参与者建议与行为健康护理建立更紧密的联系。
结论
有和没有严重精神疾病的参与者均能从“茁壮成长”项目中公平受益。
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