SERVICE USE OF DEPRESSED ELDERS AFTER ACUTE CARE

抑郁老人在紧急护理后的服务使用

• 批准号: 2416193
• 负责人: NANCY Louise MORROW-HOWELL
• 金额: $ 34.55万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-09-30 至 2000-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2416193
• 关键词: behavioral /social science research tag; clinical research; community mental health services; depression; functional ability; health care policy; health care service availability; health care service evaluation; health care service planning; health care service utilization; human old age (65+); human subject; interview; longitudinal human study; posthospitalization care; prognosis; statistics /biometry

The proposed study addresses service use of depressed elders after acute psychiatric care. Depressed elders are hospitalized for shorter periods and are discharged at higher levels of dependency to a community system of care which they underutilized. Inadequate service after discharge may undermine the effective use of expensive inpatient treatment. Yet the service use of depressed elders following hospitalization has not been examined for its impact on post-acute outcomes. This study addresses the following objectives: to identify factors related to service utilization of depressed elders after psychiatric hospitalization in four sectors of care (specialty mental health, general health, formal aging, and informal services); to assess and identify factors associated with service adequacy. operationalized as the extent to which needs for care are met. and test the relationship between service utilization and service adequacy; and to test the impact of service utilization and service adequacy on outcomes. These aims will be achieved through a prospective, longitudinal study of 275 elderly patients hospitalized for depression and discharged home. Service utilization in the six months following discharge will be measured through subject report and service provider records. Outcomes of readmission, depressive symptomatology, cognitive status, and health status will be evaluated at six months. Guided by the Andersen model, need, predisposing, and enabling factors associated with service utilization and service adequacy will be identified through regression analysis. Path analysis will be used to determine the effects of utilization and adequacy on post-acute outcomes. The study is unique in its conceptualization of service use in the four sectors of care on which the elderly depend and its empirical derivation of configurations of care representing combinations of services across these four sectors. Further, the study advances the concept of service adequacy, operationalized as the extent to which services meet patient needs for care (mental health, physical.health, and physical dependency needs). Service adequacy is conceptualized as an outcome of utilization and is viewed as a stronger predictor of post-acute outcome than is utilization per se. The study is significant in its focus on post-acute care, which will continue to grow in importance as use of inpatient care is constrained. The study responds to the recognized need for information about the critical interface between acute and community care. Knowledge generated from the study will inform discharge planning practices, home care and extended care programming, and post-hospital care reimbursement policies.

拟议的研究地址后，急性抑郁症的老年人的服务使用 精神病治疗抑郁的老人住院时间较短 并在更高的依赖程度上被释放到社区系统中 他们所忽视的关怀。放电后的不充分服务可能 削弱了昂贵的住院治疗的有效利用。然而 抑郁长者住院后的服务使用情况， 检查其对急性期后结果的影响。这项研究涉及的 确定与服务利用率有关的因素 四个界别的长者因精神病住院后抑郁的个案 护理（专业心理健康，一般健康，正式老龄化， 非正式服务）;评估和确定与 服务充分性。在多大程度上需要照顾 得到满足。并测试服务利用率与 服务是否足够;以及测试服务使用率的影响， 服务的充分性。 这些目标将通过一项前瞻性的纵向研究来实现， 275名老年患者因抑郁症住院并出院回家。 出院后六个月内的服务使用率将 通过受试者报告和服务提供商记录进行衡量。成果 再入院、抑郁症、认知状态和健康 将在六个月后对状况进行评估。在安徒生模型的指导下， 与服务相关的需求、诱发因素和促成因素 将通过回归确定利用率和服务充足性 分析.路径分析将用于确定以下因素的影响： 急性期后结果的利用率和充分性。 这项研究是独特的，在其概念化的服务使用的四个 老年人所依赖的护理部门及其经验推导 医疗服务的组合， 这四个部门。同时，提出了服务的概念 充分性，可操作性是指服务满足患者需求的程度 护理需求（心理健康，physical.health和身体依赖 需求）。服务充足性被概念化为利用率的结果 并且被认为是急性期后结果的更强预测因子， 利用本身。 这项研究的重点是急性期后护理，这将 随着住院治疗的使用受到限制，其重要性继续增长。 这项研究是为了满足人们认识到的需要， 急性和社区护理之间的关键接口。产生的知识 从研究将告知出院规划的做法，家庭护理， 扩展护理计划和住院后护理报销 施政纲要而