SERVICE SYSTEMS, ORGANIZATIONS, AND SMI PATIENT OUTCOMES

虽然近年来已经了解了很多关于 具体药理学、心理治疗学、康复学和其他 严重精神病患者的治疗，对 不同组织形式的影响，其中这种干预措施 交付的数量仍然有限。这项研究探讨了如何 该人群中的各种患者结局与不同的 提供服务的精神卫生系统的特点， 以及与提供者组织相关的各种因素， 主要负责病人的护理。患者结局将包括 症状方面，日常生活活动，社会活动， 就业和住房。患者结局与 关键概念中的特定变量和变量星座 资源、技术、结构、文化和管理类别 将检查，比较和对比代表这些变量 跨系统和提供商组织的概念。层次化建模 技术将被用来检查这些关系。统计 控制系统特征变量，如农村和 人群大小和患者严重程度变量，如既往 住院治疗，将被引入，以控制差异， 社区背景和患者组合。现有数据来自唯一的 10个独立系统的横断面研究，包括42个主要 将使用提供者组织和这些组织的353名工作人员 为了检查大约1500名患者的结果， 生活在威斯康星州农村和小城市的严重精神疾病患者。

While much has been learned in recent years about the efficacy of specific pharmacological, psychotherapeutic, rehabilitative, and other therapies for persons with severe mental illness, understandings of the effects of different organizational forms within which such interventions are delivered have remained limited. This proposed study explores how various patient outcomes in this population are related to different characteristics of mental health systems in which services are delivered, and various factors associated with the provider organizations which take primary responsibility for patients' care. Patient outcomes will include aspects of symptoms, activities of daily living, social activities, employment, and housing. The association of patient outcomes with specific variables and constellations of variables in the key conceptual categories of resources, technology, structure, culture, and management will be examined, comparing and contrasting variables representing these concepts across system and provider organizations. Hierarchical modeling techniques will be employed to examine these relationships. Statistical controls for system characteristics variables, such as rurality and population size, and for patient severity variables, such as prior hospitalizations, will be introduced to control for differences in community context and patient mix. Currently existing data from a unique cross-sectional study of 10 separate systems, including 42 primary provider organizations and 353 staff of these organizations will be used to examine the outcomes in a population of about 1500 patients with severe mental illness living in rural and small cities in Wisconsin.