Boot B, Hall W, Andrews G
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Br J Psychiatry. 1997 Sep;171:242-6. doi: 10.1192/bjp.171.3.242.
Eighteen acute in-patient psychiatric units in Australia funded a syndicate to measure case-mix, disability and outcome of treatment. This syndicate included eight units in public general hospitals, five in stand-alone public psychiatric hospitals and five in private psychiatric hospitals.
Up to 100 in-patients admitted consecutively to each hospital (1359 in all) were assigned to a Diagnosis-Related Group (DRG), rated on the Health of the Nation Outcome Scales (HoNOS) and asked to complete the Medical Outcomes Trust Short Form 36 (SF36). These scales were administered again at discharge. Demographic information and length of stay were also recorded. Disability was measured by scores on the HoNOS and SF36 at admission, and outcome was assessed by the change in scores between admission and discharge.
The public hospitals treated significantly more patients with schizophrenia and fewer with affective disorders, and their case load on admission was more disabled, on the whole, than that of the private hospitals. They achieved the same outcome or health gain as the private hospitals, but needed a shorter length of stay to do so. The addition of disability scores to DRG moderately increased the ability to predict length of stay.
Routine outcome assessment using reliable and valid instruments is practical, and could lead to improvements in the quality of care for psychiatric patients.
澳大利亚的18家急性住院精神科病房联合成立了一个财团，以衡量病例组合、残疾情况和治疗结果。该财团包括8家综合公立医院的病房、5家独立公立精神病医院的病房和5家私立精神病医院的病房。
每家医院连续收治的多达100名住院患者（共1359名）被分配到一个诊断相关组（DRG），根据《国家健康结果量表》（HoNOS）进行评分，并被要求完成《医学结果信托简短健康调查问卷36项》（SF36）。这些量表在出院时再次进行测评。还记录了人口统计学信息和住院时间。残疾情况通过入院时HoNOS和SF36的评分来衡量，治疗结果通过入院和出院之间评分的变化来评估。
公立医院治疗的精神分裂症患者明显更多，情感障碍患者更少，总体而言，其入院时的病例负担比私立医院的更严重。它们取得了与私立医院相同的治疗结果或健康改善，但所需的住院时间更短。将残疾评分添加到DRG中适度提高了预测住院时间的能力。
使用可靠且有效的工具进行常规结果评估是可行的，并且可能会改善精神病患者的护理质量。
