RELATIONSHIPS BETWEEN GEN MED & MENTAL HLTH SPECIALTY

该项目将开发一个综合模型来选择 精神障碍患者进入普通内科和普通科 专科精神卫生护理及护理内容考查 使用来自主要医院的数据来改变门诊和住院病人的设置 国家研究)非洲经委会、兰德医疗保险试验、马什菲尔德 流行病学调查、全国流动医疗保健调查) 和国家关于住院护理的数据集。在开始一项新的 产生关于护理需求的昂贵研究，选择 在治疗、护理内容等方面，都会作出周到的努力 利用现有数据开发预测性选择模型，以及 在不同的研究中测试和提炼它。建议的选择 模型基于这样的假设：需求的概念不应该 不仅要根据疾病的患病率，还要考虑主观因素 伤痛、伤残程度和伤残后果 风险和负担的症状。我们还认为，社会和 在理解时必须考虑到文化限制 对需求的回应。我们提出了一种基于八元组的选择模型 指标类别：(1)DIS/DSM-III诊断或其他措施 心理障碍；(2)苦恼的严重程度；(3)程度 (4)暴力、爆炸行为或自杀威胁的风险； 身体并存；(5)疾病对 工作和家庭；(6)心理倾向 心理和/或专科精神卫生保健；(7) 医疗保健系统的特点，包括财政 可利用的准入和专业部门资源；以及(8)文化 地理区域的特点。通过进行并行 使用不同的操作跨不同的数据集进行分析 我们计划确定稳健和更不确定的模式的定义。 我们相信，拟议的模式不仅将有助于辅助 需要和规划服务，但应有助于解释 看似可比的国家之间的资源消耗差异 病人。

This project will develop a synthetic model of the selection of patients with psychiatric disorders into general medical and specialty mental health care and examine the content of care in varying outpatient and inpatient settings using data from major national studies )ECA, Rand Health Insurance Experiment, Marshfield Epidemiological Survey, National Ambulatory Medical Care Survey) and State data sets on inpatient care. Before embarking on a new generation of expensive studies on need for care, selection into treatment, and the content of care, thorough efforts will be made to use existing data to develop a predictive selection model, and test and refine it across varying studies. The proposed selection model is based on the assumption that concepts of need should not be based on illness prevalence alone, but also on subjective distress, levels of disability and impairment, and consequences of symptoms for risk and burden. We also believe that social and cultural constraints must be taken into account in understanding responses to need. We propose a selection model based on eight classes of indicators: (1) DIS/DSM-III deagnosis or other measures of psychological disturbance; (2) severity of distress; (3) degree of risk as in violence, explosive behavior or suicide threat; (4) physical co-morbidity; (5) disruptive effects of the illness on work and family; (6) psychological propensities toward psychological and /or specialty mental health care; (7) characteristics of the medical care system including financial access and specialty sector resources available; and (8) cultural characteristics of the geographic area. By conducting parallel analyses across varying data sets using different operational definitions we plan to identify robust and more uncertain patterns. The proposed model, we believe, will not only assist in assissing need and planning services but should be helpful in explaining differences in resource consumption among seemingly comparable patients.