Rosenheck R, Frisman L, Gallup P
Northeast Program Evaluation Center, Veterans Affairs Medical Center (182), West Haven, CT 06516, USA.
Psychiatr Serv. 1995 Nov;46(11):1131-9. doi: 10.1176/ps.46.11.1131.
The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans.
Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments.
Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements.
This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.
本研究利用退伍军人事务部针对无家可归的患有精神疾病的退伍军人项目的纵向结果研究数据，考察了特定治疗要素与其成本之间的关系以及十种结果指标。
对在退伍军人事务部无家可归的慢性精神疾病退伍军人项目中接受治疗的406名患有精神疾病和物质使用障碍的无家可归退伍军人，分析了八个月期间的基线和结果数据。采用多变量技术来考察十种结果指标与六个治疗要素之间的关系：通过社区外展进入项目、与项目临床医生的接触次数、转介到其他服务的次数、参与项目的时长、住院治疗天数以及公共支持付款增加情况。
六个治疗要素中的每一个都与十种结果指标中至少一个指标的改善显著相关。与项目工作人员的临床接触次数和住院治疗天数与最多数量的结果领域的改善相关。然而，与住院治疗相关的改善成本远高于与其他治疗要素相关的改善成本。
本研究提供了多模式方法治疗无家可归的精神疾病患者有效性的证据。然而，结果表明应特别关注与各种治疗要素相关的改善成本差异。
