Peterson K A, Swindle R W, Phibbs C S, Recine B, Moos R H
Program Evaluation and Resource Center, Palo Alto VA Medical Center, Menlo Park, CA 94025.
Med Care. 1994 Jun;32(6):535-50. doi: 10.1097/00005650-199406000-00001.
This study examines program determinants of one aspect of VA inpatient substance abuse treatment program performance. Performance was measured by the ratio of a program's readmission rate to the expected rate for programs with similar patients. Six-month readmission rates in 101 VA treatment programs were analyzed. Preliminary analyses indicated that patient differences across programs accounted for 36% of the variance in readmission rates. Program differences accounted for 47% of the variance in case-mix-adjusted readmission rate. Among program factors selected through a literature review, better than expected readmission performance was associated with having fewer early discharges, a longer intended treatment duration, more patient participation in aftercare, more family or friend assessment interviews, and treating more patients on a compulsory basis. Performance was not related to stress management training, patient attendance at more self-help meetings during treatment, staff characteristics, or average staff costs per patient day. The findings indicate that treatment retention, duration, and increased aftercare may be targeted to reduce high readmission rates. Last, there were only small differences in the model over 30, 60, 90, and 365 day follow-up intervals, suggesting substantial stability of the findings.
本研究考察了退伍军人事务部（VA）住院药物滥用治疗项目绩效某一方面的项目决定因素。绩效通过一个项目的再入院率与具有相似患者的项目预期再入院率之比来衡量。对101个VA治疗项目的六个月再入院率进行了分析。初步分析表明，各项目间患者差异占再入院率方差的36%。项目差异占病例组合调整后再入院率方差的47%。在通过文献综述选定的项目因素中，优于预期的再入院表现与早期出院较少、预期治疗持续时间较长、患者更多地参与后续护理、更多的家属或朋友评估访谈以及强制治疗更多患者有关。绩效与压力管理培训、患者在治疗期间参加更多自助会议、工作人员特征或每位患者每天的平均工作人员成本无关。研究结果表明，可以针对治疗保留率、治疗持续时间和加强后续护理来降低高再入院率。最后，在30天、60天、90天和365天的随访间隔中，模型仅有微小差异，这表明研究结果具有相当的稳定性。
