Have general hospitals become chronic care institutions for the mentally ill
Have general hospitals become chronic care institutions for the mentally ill
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综合医院是否已成为精神病患者长期护理机构
DOI：
10.1176/ajp.148.7.892
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发表时间：
1991
影响因子：
17.7
通讯作者：
Marcos Lr
中科院分区：
文献类型：
--
作者：
Salit Sa;Marcos Lr
目的近年来，纽约市综合医院精神病患者的住院时间急剧增加，这引发了人们的猜测，即综合医院正在承担起照顾慢性精神病患者的巨大责任。这项研究考察了使用模式和患者特征的变化，以评估这种趋势是否正在发生。方法收集1985年和1988年纽约市综合医院所有成人精神病患者的出院摘要数据和1977-1989年公立综合医院系统的使用数据。选择了三个衡量慢性化的指标：住院时间超过60天，出院接受长期护理，以及每年三次或三次以上的入院。还回顾了慢性病患者的精神诊断和合并症诊断的数据。结果近年来，精神科病人在综合医院的平均住院时间大幅增加，而在1977-1989年间，公立医院的平均住院时间增加了近两倍。在1985年至1988年期间，全市范围内的增长主要是由于住院时间很长的患者比例越来越高。在一九八八年，住院日数超过60天的病人占所有住院日数的35%，而一九八五年则为27%。在1988年，慢性病患者占所有日数的一半，而在1985年，这一比例为38%。结论虽然许多因素导致了这些趋势，但最主要的原因是有利于短期住院护理的报销政策。改善社区治疗计划的问责制将是改变资金优先顺序并为慢性精神病患者创造更合适的替代方案的关键。
OBJECTIVE Dramatic increases in lengths of stay for general hospital psychiatric patients in New York City in recent years have raised speculation that general hospitals are assuming a large responsibility for care of the chronically mentally ill. This study examines changes in utilization patterns and patient characteristics to assess whether such a trend is occurring. METHOD The authors obtained discharge abstract data for all New York City general hospital adult psychiatric patients in 1985 and 1988 as well as utilization data from the public general hospital system for 1977-1989. Three measures of chronicity were chosen: hospital stays longer than 60 days, discharges to long-term care, and three or more admissions per year. Data on psychiatric diagnoses and comorbid diagnoses for chronically ill patients were also reviewed. RESULTS The mean length of stay of psychiatric patients in general hospitals has increased substantially in recent years and nearly tripled in the public hospitals during 1977-1989. Between 1985 and 1988, citywide increases were due largely to a growing proportion of patients with very long stays. Patients with stays longer than 60 days accounted for 35% of all inpatient days in 1988, compared with 27% in 1985. Patients with chronic illness accounted for half of all days in 1988, compared with 38% in 1985. CONCLUSIONS Although many factors have contributed to these trends, the leading cause has been reimbursement policies favoring short-term inpatient care. Improving accountability for community treatment programs will be the key to redirecting funding priorities and creating more appropriate alternatives for the chronically mentally ill.