COMMUNITY LONG TERM CARE--ELDERS WITH MENTAL DISORDERS

社区长期护理——精神障碍老人

• 批准号: 6126123
• 负责人: JEAN DEMMLER
• 金额: $ 15.03万
• 依托单位: UNIVERSITY OF DENVER (COLORADO SEMINARY)
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-12-01 至 2002-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6126123
• 关键词: Medicare /Medicaid; classification; clinical research; community mental health services; dementia; extended care; geriatrics; health care model; health care service evaluation; health care service planning; health services research tag; home health care; human data; human middle age (35-64); human old age (65+); mental disorders; meta analysis; model design /development

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.

快速发展的社区越来越多地使用基于社区的长期护理 患有神经精神疾病的老年人口不断增加 为精神卫生服务体系研究领域带来了新的成果 挑战。 临床结果和成本效益研究 需要规划医疗、心理健康和 为具有不同长期需求的个人提供社会福利服务 关心。 目前，还没有模式或组合的分类法 患有精神疾病的老年人使用的社区服务 疾病；相反，这些服务模式嵌入到更广泛的领域中 “家庭和社区服务”的服务类别或 “疗养院护理的替代方案。” 采用多种方法的方法， 这项为期两年的研究开发了基于社区的长期分类法 为老年人口提供护理服务。 的意义 研究是其对服务系统研究工具的贡献 有必要就社区的使用开展实质性政策研究 由患有精神疾病或患有精神疾病的老年人提供的基础服务 失智。 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法。 拟议的研究 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众心理健康中的有效性 服务领域。 第五步检验该方法的普遍性 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功能类型； 2）凭经验确定长期护理服务的模式 患有神经精神疾病的老年人； 3）检查一致性 利用案例管理器作为概念和经验分类法 专家关键信息提供者； 4）测试类型学的判别有效性 使用人员层面的特征作为服务模式的预测指标； 5) 评估区域和全州范围内的普遍性 构造类型。 研究人群是科罗拉多州医疗补助客户（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；研究科目包括 1998 年 1 月 1 日至少有 3 次连续服务的客户群体 几个月。 定性访谈数据和定量客户 特征和服务数据将用于开发分类法 并检验其有效性。 医疗补助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 将采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 检查有效分类的普遍性。 研究结果应 指导多状态复制以完善该工具并在将来使用 研究考察不同产品的价格和功能可替代性 可以充分替代基于社区的长期护理模式 为特定类型的老年人提供疗养院护理。