Luchins D J, Hanrahan P, Conrad K J, Savage C, Matters M D, Shinderman M
Department of Psychiatry at the University of Chicago, IL 60637, USA.
Psychiatr Serv. 1998 Sep;49(9):1218-22. doi: 10.1176/ps.49.9.1218.
Representative payee programs help severely mentally ill individuals manage money from their Social Security payments to cover expenses for necessities and to avoid homelessness and rehospitalization. This study examined a representative payee program operated by a community mental health center to determine the criteria used by clinicians and ease managers to refer clients to the program and to learn whether participation in the program was associated with reductions in hospitalization.
The retrospective study included 56 individuals with severe mental illness who were enrolled in the representative payee program at Community Counseling Centers of Chicago for one year and who also had received services from the agency for at least one year before enrollment. Criteria used to refer clients to the representative payee program were determined through chart reviews. Data on state hospitalizations before and after enrollment were available for the entire sample; additional data on Medicaid-funded private hospitalizations were available for a subset of 33 clients.
The most common criteria for enrollment in the representative payee program were comorbid substance abuse or dependence (49 percent), a history of homelessness (33 percent), and frequent hospitalizations (32 percent). During the year of participation in the representative payee program, the mean number of days spent in state hospitals decreased markedly compared with the year before enrollment, from 68 days to seven days. A similar reduction was noted in the number of days spent in state and private hospitals, from 97 days to 15 days.
Findings from this pre- and postintervention retrospective study are tentative in the absence of a more rigorous design. However, the results suggest that the representative payee program is quite effective in reducing hospital stays.
代付人计划帮助重度精神疾病患者管理其社会保障金，以支付生活必需品费用，避免无家可归和再次住院。本研究考察了一个由社区心理健康中心运营的代付人计划，以确定临床医生和个案管理员将客户转介至该计划所使用的标准，并了解参与该计划是否与住院次数减少相关。
这项回顾性研究纳入了56名重度精神疾病患者，他们在芝加哥社区咨询中心的代付人计划中登记了一年，并且在登记前至少已从该机构接受服务一年。通过查阅病历确定将客户转介至代付人计划所使用的标准。整个样本都有登记前后的州立医院住院数据；33名客户的子集还有医疗补助资助的私立医院住院的额外数据。
参与代付人计划最常见的标准是并存药物滥用或依赖（49%）、无家可归史（33%）以及频繁住院（32%）。在参与代付人计划的一年中，与登记前一年相比，在州立医院的平均住院天数显著减少，从68天降至7天。在州立医院和私立医院的住院天数也有类似减少，从97天降至15天。
在缺乏更严格设计的情况下，这项干预前后的回顾性研究结果具有不确定性。然而，结果表明代付人计划在减少住院天数方面相当有效。
