SERVICE USE OF DEPRESSED ELDERS AFTER ACUTE CARE

这项拟议的研究针对急性发作后抑郁症老年人的服务使用情况。 精神科护理。患有抑郁症的老年人住院时间较短 并以更高级别的依赖关系被释放到社区系统 他们没有充分利用的照顾。解职后的服务不足可 破坏了昂贵的住院治疗的有效利用。然而， 住院后抑郁症老年人的服务使用情况尚未得到改善 检查其对急性后结局的影响。这项研究解决了 以下目标：确定与服务利用率有关的因素 精神科住院后抑郁长者在以下四个界别的 护理(专科精神健康、一般健康、正式老龄化和 非正式服务)；评估和确定与以下方面有关的因素 服务充分性。作为需要护理的程度的可操作性 都相遇了。并测试服务利用率与服务质量的关系 服务充分性；以及测试服务利用率和 关于结果的服务充分性。 这些目标将通过前瞻性的纵向研究来实现 275名老年抑郁症患者因抑郁住院并出院。 出院后六个月内的服务使用率为 通过主题报告和服务提供商记录进行衡量。结果 重新入院、抑郁症状、认知状态和健康 状态将在六个月后进行评估。在安徒生模型的指导下， 与服务相关的需求、诱因和促成因素 使用率和服务充分性将通过回归确定 分析。将使用通径分析来确定 关于急性后结局的利用率和充分性。 这项研究在四个方面的服务使用概念化方面是独一无二的 老年人所依赖的护理部门及其经验推导 代表以下各项服务组合的护理配置 这四个板块。此外，研究还提出了服务的概念 充分性，根据服务满足患者的程度进行操作 需要护理(心理健康、身体健康和身体依赖) 需求)。服务充分性被概念化为利用的结果 被认为是预测急性后遗症预后的更好的指标 本身的利用率。 这项研究的重点是急性后护理，这将是 随着住院护理的使用受到限制，其重要性继续增长。 这项研究回应了公认的对信息的需求 急性护理和社区护理之间的关键接口。生成的知识 这项研究将为出院规划实践、家庭护理和 延长护理方案和住院后护理报销 政策。

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.