Rabiner D J, Stearns S C, Mutran E
Center for Health Services Research, University of North Carolina at Chapel Hill 27599-7590.
Health Serv Res. 1994 Dec;29(5):605-22.
This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization.
Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects.
Secondary data analysis of the National Long-Term Care Data Set.
The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found.
This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use.
本研究探讨了参与以家庭/社区为基础的长期护理病例管理干预措施（即“引导示范项目”）、使用正规居家护理与后续养老院使用情况之间的关系。
对随机分组的“引导”干预措施进行结构分析，以将“引导”对养老院使用的总体影响分解为直接影响和间接影响。
对国家长期护理数据集进行二次数据分析。
“引导”干预措施增加了正规居家护理的使用，而这与12个月时的养老院使用情况呈正相关。然而，“引导”对养老院使用的负面直接影响幅度足以抵消这种正面间接影响，因此发现“引导”对后续养老院使用有微小但显著的负面总体影响。
本研究说明了“引导”为何对养老院使用没有产生很大的总体影响。该分析没有提供居家护理直接替代养老院护理的证据，因为“引导”其他方面（包括但不限于病例管理）导致的养老院使用直接减少，被与额外居家护理使用相关的养老院使用间接增加所大幅抵消。
