Trent L K
Health Sciences and Epidemiology Department, Naval Health Research Center, San Diego, California 92186-5122, USA.
J Stud Alcohol. 1998 May;59(3):270-9. doi: 10.15288/jsa.1998.59.270.
Attempts to balance escalating health care costs with resource downsizing have prompted alcohol treatment directors in the U.S. Navy to consider reducing the standard length of stay in treatment. The objectives of this study were to (1) determine whether a 4-week inpatient treatment program is as effective as a 6-week program, and (2) explore the potential for matching patients to a 4- or 6-week program according to the severity of their condition at intake.
A total of 2,823 active-duty alcohol-dependent inpatients (2,685 men, 138 women) at 12 Navy treatment facilities participated in the evaluation. All facilities conducted a 6-week program until data had been collected for 1,380 participants; they then switched to a 4-week program (n = 1,443). Background information and clinical profile were obtained when patients entered treatment; 1-year outcome data (e.g., alcohol use, behavior problems, job performance, quality of life) were obtained from participants, work supervisors and aftercare advisors. Hierarchical multiple regression analyses were used to assess the effect of length of stay on outcome and to examine patient-program interactions.
The single best predictor of success at 1 year was months of aftercare attendance. Program membership failed to explain any of the observed differences in the criterion measures, once the effects of other predictors had been taken into account. Severity of condition and patient-program interactions were likewise nonsignificant.
It was concluded that a reduction in length of stay from 6 weeks to 4 weeks in the Navy's inpatient alcohol treatment program would not have an adverse effect on outcome.
在美国海军中,试图在不断攀升的医疗成本与资源缩减之间取得平衡,促使酒精治疗主任们考虑缩短治疗的标准住院时长。本研究的目的是:(1)确定为期4周的住院治疗项目是否与为期6周的项目效果相同;(2)根据患者入院时病情的严重程度,探索将患者匹配到为期4周或6周项目的可能性。
12家海军治疗机构的总共2823名现役酒精依赖住院患者(2685名男性,138名女性)参与了评估。在为1380名参与者收集完数据之前,所有机构都开展为期6周的项目;之后他们转而采用为期4周的项目(n = 1443)。在患者入院接受治疗时获取其背景信息和临床资料;从参与者、工作主管和后续护理顾问处获取1年的结果数据(例如,饮酒情况、行为问题、工作表现、生活质量)。采用分层多元回归分析来评估住院时长对结果的影响,并检验患者与项目的相互作用。
1年后成功的最佳单一预测因素是后续护理的出勤月数。一旦考虑了其他预测因素的影响,项目参与情况无法解释在标准测量中观察到的任何差异。病情严重程度以及患者与项目的相互作用同样不显著。
得出的结论是,海军住院酒精治疗项目的住院时长从6周减至4周不会对结果产生不利影响。