Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals.
Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals.
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DOI：
10.1176/ajp.156.12.1968
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发表时间：
1999-12
期刊：
影响因子：
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通讯作者：
M. Swartz;J. Swanson;H. Wagner;Barbara J. Burns;V. Hiday;Randy Borum
中科院分区：
文献类型：
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作者：
M. Swartz;J. Swanson;H. Wagner;Barbara J. Burns;V. Hiday;Randy Borum
目的探讨非自愿门诊承诺在减少严重精神疾病患者再住院中的作用。方法将非自愿住院的受试者随机分为出院后出院组135例和门诊承诺组129例，随访1年。每个受试者都接受了病例管理服务和额外的门诊治疗。收集了门诊治疗和住院使用数据。结果在双变量分析中，控制组和门诊承诺组在住院结果上没有显著差异。然而，与对照受试者相比，那些经历了超过最初法院命令的持续门诊承诺的受试者再入院时间减少了约57%，住院天数减少了20天。持续的门诊承诺被证明对患有非情感性精神障碍的个人特别有效，减少了大约72%的再次住院，并减少了28天的住院天数。在重复测量多变量分析中，即使不考虑法院下令的门诊承诺的总时长，门诊承诺组的住院结果也明显更好。然而，在随后对门诊治疗在精神障碍患者中的作用进行的反复测量分析中，也发现持续的门诊承诺只有在结合更高强度的门诊治疗时才能减少再次住院。结论当法院命令持续并结合强化治疗时，门诊承诺可以减少再次住院和总住院天数，特别是对精神障碍患者。这种门诊承诺的使用不能替代强化治疗；它需要大量承诺治疗资源才能有效。
OBJECTIVE The goal of this study was to evaluate the effectiveness of involuntary outpatient commitment in reducing rehospitalizations among individuals with severe mental illnesses. METHOD Subjects who were hospitalized involuntarily were randomly assigned to be released (N = 135) or to continue under outpatient commitment (N = 129) after hospital discharge and followed for 1 year. Each subject received case management services plus additional outpatient treatment. Outpatient treatment and hospital use data were collected. RESULTS In bivariate analyses, the control and outpatient commitment groups did not differ significantly in hospital outcomes. However, subjects who underwent sustained periods of outpatient commitment beyond that of the initial court order had approximately 57% fewer readmissions and 20 fewer hospital days than control subjects. Sustained outpatient commitment was shown to be particularly effective for individuals with nonaffective psychotic disorders, reducing hospital readmissions approximately 72% and requiring 28 fewer hospital days. In repeated measures multivariable analyses, the outpatient commitment group had significantly better hospital outcomes, even without considering the total length of court-ordered outpatient commitments. However, in subsequent repeated measures analyses examining the role of outpatient treatment among psychotically disordered individuals, it was also found that sustained outpatient commitment reduced hospital readmissions only when combined with a higher intensity of outpatient treatment. CONCLUSIONS Outpatient commitment can work to reduce hospital readmissions and total hospital days when court orders are sustained and combined with intensive treatment, particularly for individuals with psychotic disorders. This use of outpatient commitment is not a substitute for intensive treatment; it requires a substantial commitment of treatment resources to be effective.