COMMUNITY LONG TERM CARE--ELDERS WITH MENTAL DISORDERS

以社区为基础的长期护理的使用量迅速增加 患有神经精神障碍的老年人人数不断增加 介绍了精神卫生服务体系研究领域的新进展 挑战。临床结果和成本效益研究 需要计划适当的医疗、心理健康和 为长期有不同需要的个人提供的社会福利服务 关心。目前，还没有模式或组合的分类 以社区为基础的服务，由患有精神疾病的老年人使用 疾病；相反，这些服务模式嵌入了更广泛的 “居家及社区服务”服务类别或 “养老院护理的替代方案。”使用多方法方法， 这项为期两年的研究开发了一种基于社区的长期 为这一老年人口提供护理服务。这一事件的意义 研究是其对服务系统研究的一种贡献 就使用社区--进行实质性的政策研究- 由患有精神疾病或精神疾病的老年人提供的服务 痴呆症。本研究的总体目标是构建一个有效的 使用科罗拉多州长期护理系统的分类学。建议进行的研究 有五个步骤。前四个步骤发展了群落的分类-- 以长期护理为基础并检验其在当地公共心理健康中的有效性 服务区。第五步考察了 已验证的构造类型。这些步骤：1)开发概念模型 家庭和社区长期护理服务的职能类型； 2)经验性地确定下列国家使用的长期护理服务模式 患有神经精神障碍的老年人；3)检查一致性 使用案例经理作为概念和经验分类的 专家关键信息者；4)检验类型学的判别有效性 使用个人层面的特征作为服务模式的预测因子； 以及5)评估区域和州范围内的可推广性 构造的类型。 研究人群是科罗拉多州的医疗补助客户(60岁及以上) 患有严重精神疾病或痴呆症的人参加家庭和 以社区为基础的长期护理计划；研究对象包括 1998年1月1日的客户群体，至少有3次连续服务 月份。定性访谈数据和定量客户 将使用特征和服务数据来制定分类法 并检验其有效性。医疗补助已支付索赔的二次数据分析 数据将根据经验对服务模式进行分类；多变量 将使用分析技术来测试这些方法的有效性 分类。元分析统计技术将用于 检查有效分类的概括性。调查结果应该是 指导多状态复制以完善该工具并在未来使用 变量的价格和功能可替代性研究 基于社区的长期护理模式，可以充分取代 为选定类型的老年人提供养老院护理。

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.