Hendryx M S, Rohland B M
Washington Institute for Mental Illness, Research and Training, Department of Psychology, Washington State University-Spokane 99204, USA.
Community Ment Health J. 1997 Feb;33(1):63-73. doi: 10.1023/a:1022421312162.
The decision to recommend hospitalization for patients with psychiatric illness is often made on the basis of unknown reliability and validity. The purpose of this study was to examine the characteristics and reliability of self-reported psychiatric hospitalization decision making among staff at a Community Mental Health Center. Foremost among the results, the conditions that staff consider to be appropriate indicators of hospitalization show only modest reliability. Kappa interrater reliabilities of .10 to .60 persist across different staff types and different patient problems. Results from hypothetical cases support a micro-certainty, macro-uncertainty hypothesis: staff are highly confident in the appropriateness of their treatment recommendations, but the recommendations across staff are variable. The results empirically demonstrate the need to improve the reliability of the hospitalization decision, and to work towards valid outcomes-based hospitalization criteria.
对于患有精神疾病的患者，推荐其住院治疗的决定往往是基于可靠性和有效性未知的依据做出的。本研究的目的是调查社区心理健康中心工作人员自我报告的精神科住院治疗决策的特征和可靠性。在各项结果中，最为重要的是，工作人员认为适合作为住院指标的条件，其可靠性仅为中等。不同类型的工作人员以及不同的患者问题，其评定者间的Kappa信度在0.10至0.60之间。假设案例的结果支持了微观确定性、宏观不确定性的假设：工作人员对其治疗建议的适当性高度自信，但不同工作人员的建议却存在差异。研究结果从实证角度证明，有必要提高住院决策的可靠性，并朝着基于有效结果的住院标准努力。
