COMMUNITY LONG TERM CARE--ELDERS WITH MENTAL DISORDERS

越来越多地使用社区为基础的长期护理， 患有神经精神疾病的老年人人数不断增加 提出了新的精神卫生服务体系研究领域 挑战 临床结果和成本效益研究是 需要计划适当的医疗、心理健康和 为有不同需要的人士提供的社会福利服务， 在乎 目前，没有模式或组合的分类法 老年精神病患者使用的社区服务 相反，这些服务模式是嵌入在更广泛的 “家居及社区服务”的服务类别，或 “养老院护理的替代方案。“采用多种方法， 这项为期两年的研究开发了一种基于社区的长期 为老年人提供医疗服务。 的意义 研究是其对服务系统研究的一种工具贡献 需要进行实质性的政策研究，以利用社区- 为患有精神疾病或 痴呆 本研究的总体目标是构建一个有效的 分类使用科罗拉多的长期护理系统。 拟定研究 有五个步骤。 前四个步骤发展了社区的分类- 基于长期护理，并测试其在当地公共精神卫生的有效性 服务领域。 第五步考察了 验证构造类型。这些步骤：1）建立一个概念模型 家庭和社区长期护理服务的功能类型; 2)根据经验确定长期护理服务的模式， 老年人神经精神障碍; 3）检查一致性 的概念和经验分类法，利用个案经理， 专家关键信息提供者; 4）检验类型学的判别效度 使用个人层面的特征作为服务模式的预测因素; （5）评估区域和国家范围内的普遍性， 构造类型。 研究人群为科罗拉多医疗补助计划的客户（60岁及以上） 患有严重精神疾病或痴呆症的人参加家庭和 基于社区的长期护理计划;研究对象包括 1998年1月1日至少有3个连续服务的客户群 个月 定性访谈数据和定量客户 特征和服务数据将用于制定分类法 并测试其有效性。 医疗补助支付索赔的次要数据分析 数据将根据经验对服务模式进行分类;多变量 分析技术将被用来测试这些有效性 分类。 荟萃分析统计技术将用于 检查有效分类的普遍性。 研究结果应该 引导多状态复制以改进工具并在未来使用 研究，以审查价格和功能的替代性， 以社区为基础的长期护理模式， 为选定类型的老年人提供疗养院护理。

The increasing use of community-based long-term care by a rapidly expanding population of older adults with neuro-psychiatric disorders presents the field of mental health service system research with new challenges. Clinical outcomes and cost-effectiveness research are required to plan adequate combinations of medical, mental health and social welfare services for individuals with varying needs for long-term care. Currently, there is no taxonomy of the patterns or combinations of community-based services which are used by older adults with mental disorders; rather these service patterns are embedded in the broader service categories of "home and community-based services" or "alternatives to nursing home care." Using a multi-method approach, this two-year study develops a taxonomy of community-based long-term care services for this older adult population. The significance of the research is its contribution of a tool for service system research necessary to conduct substantive policy studies on the use of community- based services by older persons who have either mental illness or dementia. The overall aim of the research is to construct a valid taxonomy using Colorado's system of long-term care. The proposed study has five steps. The first four steps develop the taxonomy of community- based long-term care and test its validity in local public mental health service areas. The fifth step examines the generalizability of the validated constructed types. These steps: 1) develop a conceptual model of functional types of home and community-based long-term care services; 2) empirically identify patterns of long-term care services used by older adults with neuropsychiatric disorders; 3) examine the congruence of the conceptual and empirical taxonomies utilizing case managers as expert key informants; 4) test the discriminant validity of the typology using person-level characteristics as predictors of service patterns; and 5) assess regional and state-wide generalizability of the constructed types. The study population is Colorado Medicaid clients (60 years and older) with major mental illness or dementia who participate in Home and Community-based Long-term Care Programs; study subjects comprise the client universe on Jan. 1, 1998 who had at least 3 continuous service months. Both qualitative interview data and quantitative client characteristics and service data will be used to develop the taxonomy and test its validity. Secondary data analyses of Medicaid paid claims data will empirically classify patterns of services; multivariate analytic techniques will be employed to test the validity of these classifications. Meta-analytic statistical techniques will be used to examine generalizability of valid classifications. The findings should guide multi-state replications to refine the tool and be used in future research to examine price and functional substitutability of varying community-based models of long-term care that can adequately replace nursing home care for selected types of older persons.