Yohanna D, Christopher N J, Lyons J S, Miller S I, Slomowitz M, Bultema J K
Northwestern University Medical School, Chicago, IL 60611, USA.
J Behav Health Serv Res. 1998 Aug;25(3):337-45. doi: 10.1007/BF02287472.
Since the rapid expansion of managed care coupled with dramatic reductions in lengths of inpatient stay, there is widespread concern that the emphasis on cost containment is eclipsing attention to patient care. The present study was undertaken to evaluate speculations that the majority of short-stay (less than 48 hours) admissions to a psychiatric inpatient service at a large teaching hospital in the midwestern United States consisted of public pay patients who were rapidly transferred to area state hospitals. Using two cases mix measures, severity of illness and changes in acuity and clinical outcomes of a sample of short-stay (n = 77) and longer stay (n = 145) admissions were compared. Short-stay admissions, although similar to longer stay patients in terms of demographics, Axis I diagnosis, payer status, and appropriateness of admission, are clinically distinct. The use of nonhospital alternatives in treating a subsample of suicidal patients and the implications for improved mental health services delivery are discussed.
随着管理式医疗的迅速扩张，再加上住院时间大幅缩短，人们普遍担心对成本控制的强调正在使对患者护理的关注黯然失色。本研究旨在评估一种推测，即美国中西部一家大型教学医院精神科住院部的大多数短期住院（少于48小时）患者是公费患者，他们被迅速转至当地的州立医院。使用两种病例组合指标，对短期住院（n = 77）和长期住院（n = 145）样本患者的疾病严重程度、病情 acuity 变化及临床结局进行了比较。短期住院患者尽管在人口统计学、轴I诊断、支付者状态及入院适宜性方面与长期住院患者相似，但在临床上有所不同。文中讨论了在治疗部分自杀患者时使用非住院替代方案的情况以及对改善心理健康服务提供的影响。
