White C L, Bateman A, Fisher W H, Geller J L
Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655, USA.
Psychiatr Serv. 1995 May;46(5):467-72. doi: 10.1176/ps.46.5.467.
The study examined factors associated with admission to public and private hospitals from a mental health care emergency screening system operating under a longstanding mandate to maximize use of private inpatient treatment.
For 206 patients evaluated at the mental health emergency screening site over a two-and-a-half-month period, data were collected on demographic and clinical characteristics, admission history, services received during the emergency encounter, system variables such as time the patient spent at the emergency screening site, number of admission sites asked to accept the patient, and all reasons cited by providers for refusing to admit the patient. Logistic regression was used to develop a model of factors most likely and least likely to be associated with private hospitalization.
Overall, 60 percent of the sample was refused admission by one or more providers, and 55 percent, who were not accepted by and private hospital, became public patients. Private hospital admission was associated with patient or family involvement in referral and disposition, private or Medicaid insurance, a presenting problem of depression or suicidality, and longer time spent at the emergency screening site. Public admission was associated with no insurance, a past history of major public hospitalization, current or past history of assaultiveness, a presenting problem of aggression, and lack of any discharge site.
Private providers are reluctant to admit patients who have characteristics associated with public hospitalization. In the restructuring of health care, a more fully privatized system will likely be called on to absorb such patients. Their care, treatment, and impact on the system should be carefully monitored and evaluated.
本研究调查了在一项长期任务要求下运行的心理健康护理紧急筛查系统中，与公立和私立医院收治情况相关的因素，该任务旨在最大限度地利用私立住院治疗。
在两个半月的时间里，对在心理健康紧急筛查点接受评估的206名患者收集了人口统计学和临床特征、入院史、紧急就诊期间接受的服务、系统变量（如患者在紧急筛查点花费的时间、被要求接收患者的入院机构数量）以及提供者拒绝收治患者所列举的所有原因等数据。采用逻辑回归分析建立了最有可能和最不可能与私立住院治疗相关的因素模型。
总体而言，60%的样本被一个或多个提供者拒绝收治，55%未被私立医院接受的患者成为了公立患者。私立医院收治与患者或家属参与转诊和处置、拥有私立或医疗补助保险、存在抑郁或自杀倾向的就诊问题以及在紧急筛查点花费更长时间有关。公立收治与无保险、有过大型公立住院治疗史、当前或过去有攻击性病史、存在攻击性行为的就诊问题以及没有任何出院机构有关。
私立医疗机构不愿收治具有与公立住院治疗相关特征的患者。在医疗保健重组过程中，可能需要一个更加完全私有化的系统来接纳这类患者。应对他们的护理、治疗及其对系统的影响进行仔细监测和评估。
