Fisher W H, Simon L, Geller J L, Penk W E, Irvin E A, White C L
University of Massachusetts Medical School, Worcester 01655, USA.
Psychiatr Serv. 1996 Mar;47(3):255-62. doi: 10.1176/ps.47.3.255.
The study examined whether local variations in levels of community-based services affect the case mix of state hospitals undergoing census reduction.
Trends in case mix over a 14-year period were analyzed at two Massachusetts state hospitals, one of which underwent more rapid census reduction due to expanded community resources in the catchment area it served. Data on patients' hospital use and on sociodemographic and diagnostic characteristics obtained from 1977, 1986, and 1991 assessments of the hospitals' populations were compared. These time points represented the beginning, midpoint, and end of the census reduction period. Data from 1991 on patients' behavioral and functional status were also examined.
Parallel trends on many dimensions were evident at the two hospitals as their censuses fell. By 1986 the hospital operating in the area with greater community services had fewer elderly and long-stay patients but a higher number of admissions per patient. In 1991 this hospital's population also had more patients with high-risk violent behaviors and lower levels of functioning.
Although alternative treatment settings allow diversion of many types of patients from state hospitals, expanded community-based services and alternative inpatient beds have not diverted some patient subgroups, including recidivists and patients with behaviors that present risks in other settings. Plans for meeting the clinical needs and behavioral challenges posed by such patients must be part of any further deinstitutionalization or privatization efforts.
本研究探讨基于社区的服务水平的局部差异是否会影响正在进行普查人数减少的州立医院的病例组合。
对马萨诸塞州的两家州立医院14年间的病例组合趋势进行了分析，其中一家医院由于其服务集水区社区资源的扩大，普查人数减少得更快。比较了从1977年、1986年和1991年对医院人群评估中获得的患者住院使用情况以及社会人口统计学和诊断特征数据。这些时间点代表了普查人数减少期的开始、中期和结束。还检查了1991年患者行为和功能状态的数据。
随着两家医院普查人数的下降，在许多方面都出现了平行趋势。到1986年，在社区服务更完善地区运营的医院老年患者和长期住院患者较少，但每位患者的入院人数较多。1991年，这家医院的人群中高危暴力行为患者也更多，功能水平更低。
虽然替代治疗环境使许多类型的患者不再进入州立医院，但扩大的社区服务和替代住院床位并未使一些患者亚组分流，包括累犯和在其他环境中有风险行为的患者。满足此类患者临床需求和行为挑战的计划必须成为任何进一步去机构化或私有化努力的一部分。
