Linn M W, Gurel L, Williford W O, Overall J, Gurland B, Laughlin P, Barchiesi A
Arch Gen Psychiatry. 1985 Jun;42(6):544-51. doi: 10.1001/archpsyc.1985.01790290022002.
Nursing homes have played a major role in deinstitutionalization, and their increased use for the mentally ill has been questioned. We performed a controlled study of nursing homes as an alternative to continued psychiatric hospitalization. Men (N = 403) referred for nursing home placement from eight Veterans Administration medical centers were randomly assigned to community nursing homes (CNHs), Veterans Administration nursing care units, continued care on the same ward, or transfer to another psychiatric ward. Patients met defined criteria for schizophrenia or organic brain disease. Data were collected before random assignment and six and 12 months later, covering physical and mental function, psychopathology, mood, social adjustment, satisfaction with care, as well as drug use, characteristics of settings, and movement in and out of settings. Significant differences between settings were found in self-care, behavioral deterioration, mental confusion, depression, and satisfaction with care. Results were strikingly consistent, showing the group transferred to another ward doing better and the CNH group doing worse. Drug use did not differ from six months before entering the study or later between the settings. Cost showed a marked advantage for the CNH group. Thus, the less costly community nursing home alternative must be viewed in the context of the nonmonetary costs of less favorable patient outcome.
疗养院在去机构化过程中发挥了重要作用，但其对精神病患者使用的增加受到了质疑。我们进行了一项关于疗养院的对照研究，将其作为持续精神病住院治疗的替代方案。从八个退伍军人管理局医疗中心被转介到疗养院安置的男性（N = 403）被随机分配到社区疗养院（CNH）、退伍军人管理局护理单元、在同一病房继续护理或转至另一个精神科病房。患者符合精神分裂症或器质性脑疾病的既定标准。在随机分配前以及6个月和12个月后收集数据，涵盖身体和心理功能、精神病理学、情绪、社会适应、对护理的满意度，以及药物使用、环境特征和进出环境的情况。在自我护理、行为恶化、精神错乱、抑郁和对护理的满意度方面发现了不同环境之间的显著差异。结果惊人地一致，表明转至另一个病房的组情况较好，而社区疗养院组情况较差。药物使用与进入研究前6个月或不同环境之间的后期情况没有差异。成本显示社区疗养院组具有明显优势。因此，成本较低的社区疗养院替代方案必须在患者预后较差的非货币成本背景下看待。
