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The Precursors and Impacts of Psychiatric Facility Closure

精神病机构关闭的前兆和影响

基本信息

批准号：
7331462
负责人：
ANOUK L GRUBAUGH
金额：
$ 28.28万
依托单位：
MEDICAL UNIVERSITY OF SOUTH CAROLINA
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-12-15 至 2009-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7331462
关键词：
Accident and Emergency department Accounting Acute Admission activity Adverse effects Affect Ambulatory Care American Hospital Association Beds Birds Budgets Caring Case Mixes Characteristics Climate Closure Communities Complement Condition Data Emergency Situation Environment Facility Designs Failure General Hospitals Goals Government Hand Health Care Costs Health Personnel Health Services Accessibility Healthcare Hospital Closures Hospitals Industry Inpatients Institution Institutionalization Law Enforcement Laws Lead Managed Care Marketing Measures Medicare Mental Health Methods Numbers Outcome Ownership Patient Care Patients Pattern Perception Policies Policy Maker Private Hospitals Psychiatric Diagnosis Psychiatric Hospitals Psychiatric therapeutic procedure Public Facilities Public Hospitals Reaction Research Research Design Research Infrastructure Residential Treatment Running Societies State Hospitals Structure Surveys Symptoms System Time United States Work base cost court experience improved medical specialties payment prevent prospective success trend

项目摘要

DESCRIPTION (provided by applicant): There have been a substantial number of private inpatient psychiatric hospital closures over the past decade. Close to 40% of the private specialty psychiatric hospitals closed between 1995 and 2004. Despite this, there has not been a national study of the determinants or the effect of private inpatient psychiatric care closure. The reduction in the number of state psychiatric hospitals was less dramatic during this time period, likely due to the fact that state capacity declined significantly in earlier years. A large number of psychiatric units in general hospitals also closed during this period. On the one hand, this closure may reflect a general shift towards outpatient care that has been occurring over the past several decades. On the other hand, it may be a result of poor reimbursement which makes financially viable of psychiatric inpatient care impracticable. If inpatient psychiatric care is not financially viable too much closure would occur and access to care would be compromised. Most of the health care in the United States is delivered by private firms; whether they be nonprofit or for-profit facilities. Regardless of ownership, the system cannot function if firms cannot cover the costs of delivering care. We propose to study the delivery of inpatient psychiatric care and access 1) whether closure is due to 'lack of demand' or instead 'lack of reimbursement' and 2) whether closure has led to access problems as defined by psychiatric admissions through the emergency department or directed the a court of law. While studying the determinants of closure is a straightforward quantitative analysis, studying the effect of closure on access is more difficult to study solely using a quantitative approach. Thus, we propose to perform of qualitative study of markets that have experienced a major hospital closure to fully understand the implications of a closure of a major facility. The qualitative study will complement a quantitative study designed to measure the effect of closure on access. Our study will focus on a mix of markets that have been affected by the closure of both public and private facilities. There is likely to be a crucial difference between the closure of public and private facilities. Public facility closure is likely to occur after adequate alternative care exists in the community. In contrast, private facility closure occurs when the facility is no longer financially viable and thus may or may not be a function of the quality and quantity of alternatives in the community.

描述（由申请人提供）：在过去十年中，有大量的私人住院精神病医院关闭。在1995年至2004年期间，将近40%的私立精神病专科医院关闭。尽管如此，还没有一个全国性的研究的决定因素或私人住院精神病护理关闭的影响。在此期间，州立精神病医院数量的减少不那么明显，这可能是因为早些年州立精神病医院的能力大幅下降。在此期间，综合医院的许多精神科也关闭了。一方面，这种关闭可能反映了过去几十年来一直发生的向门诊治疗的普遍转变。另一方面，这可能是由于补偿不足，使得精神病住院治疗在经济上不可行。如果住院精神病治疗在经济上不可行，就会发生太多的关闭，获得治疗的机会也会受到影响。美国的大部分医疗保健都是由私营公司提供的，无论它们是非营利性的还是营利性的。无论所有权如何，如果公司无法支付提供护理的费用，该系统就无法运作。我们建议研究提供住院精神病护理和访问1）关闭是否是由于“缺乏需求”或相反的“缺乏报销”和2）关闭是否导致访问问题所定义的精神病入院通过急诊科或指示法院。虽然研究封闭的决定因素是一种简单的定量分析，但研究封闭对获取的影响则更难以单独使用定量方法进行研究。因此，我们建议对经历过大型医院关闭的市场进行定性研究，以充分了解关闭大型设施的影响。定性研究将补充定量研究，以衡量封闭对获取的影响。我们的研究将集中于受到公共和私人设施关闭影响的市场。关闭公共设施和关闭私人设施之间可能存在着重大区别。在社区存在适当的替代照料之后，公共设施可能会关闭。与此相反，私营设施的关闭发生在该设施在财政上不再可行时，因此可能是也可能不是社区替代品的质量和数量的函数。