Margolis L H, Petti R D
Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill 27599-7400.
Health Serv Res. 1994 Jun;29(2):155-67.
We analyze the costs and benefits of two strategies-intensive home-based services and increased remuneration for providers of community-based placements--to decrease excessive length of stay in a children's psychiatric hospital.
Clinical, demographic, and financial data were collected retrospectively on all children discharged during 1987 through 1989 from the state children's psychiatric hospital that serves Wayne County, Michigan. Characteristics of the discharged children were similar to those reported in other studies of intensive home-based services.
A sample of 22 children was used for a simulation analysis. Excessive length of stay was defined as the duration of hospitalization after readiness for discharge and associated planning were indicated in the record. For the simulated analysis of the intensive home-based program, costs included estimated charges for the program and charges for the children hospitalized due to failure of the intervention. For analysis of the increased remuneration strategy, costs included charges for the out-of-home placement and charges for hospitalization. For both strategies benefits were defined as averted hospitalization charges.
DATA COLLECTION/EXTRACTION METHODS: Charts of the discharged children were reviewed and 21 clinical, demographic, and financial variables were extracted.
Analysis of costs and benefits of intensive home-based services produced a favorable cost-benefit ratio of .47. Analysis of the strategy to increase remuneration for providers of community-based placements resulted in a cost-benefit ratio of 1, indicating no financial savings.
Intensive home-based services represent an efficient strategy to decrease excessive length of stay for children in psychiatric hospitals by averting hospitalization altogether. Although increased remuneration to providers of community-based placements in order to increase the supply of placements as a means to hasten discharge from the hospital has a neutral cost-benefit ratio, the opportunity to provide care in the "least restrictive" environment argues in its favor as well.
我们分析两种策略的成本与效益，即强化家庭服务和提高社区安置服务提供者的报酬，以减少儿童精神病院过长的住院时间。
回顾性收集了1987年至1989年期间从为密歇根州韦恩县服务的州立儿童精神病院出院的所有儿童的临床、人口统计学和财务数据。出院儿童的特征与其他强化家庭服务研究中报告的特征相似。
选取22名儿童样本进行模拟分析。过长住院时间定义为记录中显示已准备好出院并进行相关规划后仍继续住院的时长。对于强化家庭服务项目的模拟分析，成本包括该项目的估计费用以及因干预失败而住院的儿童的费用。对于提高报酬策略的分析，成本包括院外安置费用和住院费用。两种策略的效益均定义为避免的住院费用。
数据收集/提取方法：查阅出院儿童的病历，并提取21个临床、人口统计学和财务变量。
强化家庭服务的成本效益分析得出了有利的成本效益比，为0.47。提高社区安置服务提供者报酬策略的成本效益分析得出的成本效益比为1，表明没有节省资金。
强化家庭服务是一种有效的策略，可通过完全避免住院来减少儿童在精神病院的过长住院时间。尽管提高社区安置服务提供者的报酬以增加安置数量作为加快出院的一种手段，其成本效益比为中性，但在“限制最少”的环境中提供护理的机会也对其有利。
