Dockrell J E, Gaskell G D, Normand C, Rehman H
Department of Child Development and Primary Education, Institute of Education, University of London, England.
Soc Sci Med. 1995 Apr;40(7):895-901. doi: 10.1016/0277-9536(94)00139-k.
New models of care are needed following the closure of long-stay mental handicap hospitals. Based on an evaluation of a recently established assessment and treatment service in south-east England, this paper is concerned with the costs and likely benefits of different patterns of services for people with mild learning disabilities and severely challenging behaviour. Different models of provision are compared in terms of their costs and quality of life opportunities for clients. The assessment and treatment services provided a better understanding of the care needs, and achieved a reduction in challenging behaviours. It was therefore possible to give access to care settings closer to a normal life. For approximately 25% additional expenditure, 20 out of 34 clients who received the service moved to community placements, including three who had been referred following a breakdown in the community. If community care is to be implemented as a policy for clients with learning disabilities and serious challenging behaviours, it is necessary to recognise the financial implications. Better quality of life opportunities for this client group are associated with higher costs. When seen in the dynamic context of the costs and quality of life opportunities of the subsequent care, a high cost assessment and treatment service may be a good investment. On current evidence, the additional benefits of community homes, with a closer association with the local community, and greater freedom for clients is bought only at quite a high cost.
长期住院的智力障碍医院关闭后，需要新的护理模式。基于对英格兰东南部最近设立的评估与治疗服务的一项评估，本文关注为轻度学习障碍和严重挑战性行为患者提供不同服务模式的成本及可能带来的益处。从成本以及为客户提供的生活质量机会方面对不同的服务提供模式进行了比较。评估与治疗服务使人们对护理需求有了更好的理解，并减少了挑战性行为。因此，有可能让患者进入更接近正常生活的护理环境。在额外支出约25%的情况下，接受该服务的34名客户中有20人转到了社区安置点，其中包括3名在社区病情恶化后被转诊的患者。如果要将社区护理作为针对有学习障碍和严重挑战性行为患者的一项政策来实施，就有必要认识到其财务影响。该客户群体更好的生活质量机会与更高的成本相关。从后续护理的成本和生活质量机会的动态背景来看，一项高成本的评估与治疗服务可能是一项不错的投资。根据目前的证据，与当地社区联系更紧密、客户有更大自由的社区之家所带来的额外益处，是以相当高的成本换来的。
