A Comparison of the Cost-Effectiveness of Hospital-Based Home Care with That of a Conventional Outpatient Follow-Up for Patients with Mental Illness

精神疾患病人以醫院為基礎之居家照護與傳統門診追蹤之成本效果分析

蔡欣玲(Sing-Ling Tsai)；陳美碧(Mei-Bih Chen)；尹祚芊(Teresa J. C. Yin)

成本效果分析 ； 居家照護 ； 精神疾病 ； cost-effectiveness analysis ； home care ； patients with mental illness

The Journal of Nursing Research

13卷3期（2005 / 09 / 01）

165 - 173

英文

以成本效果分析方法，比較以醫院為基礎居家照護模式與傳統門診追蹤模式精神疾患病人之達成成果。採回溯性雙組後測之研究設計，對象採自某醫學中心精神科提供居家照護二次以上之精神病患40名為居家照護組，以及與其同期出院但僅接受傳統門診追蹤之精神病患40名為傳統照護組。研究方法以結構式問卷，面對面訪談方式收集病患之疾病維持行為、精神症狀、社會功能及服務滿意度等四種效果指標，並收集費用資料，每位病人之費用為各項精神科服務費用之總合。研究結果顯示：居家照護組之成本效果比值為4.3，傳統門診追蹤之成本效果比值為13.5，居家照護組之病患在疾病維持行為方面，有較高的門診追蹤固定性、服藥遵從性等，同時亦具較輕的精神症狀、較佳的社會功能及較高的服務滿意度，故而以醫院為基礎之居家照護模式較具成本效果優勢。本研究證實「以醫院為基礎之精神科居家照護」確可有效地提高精神病患之治療效益，研究結果提供政策制定者重新考量居家照護的資源分配。

The purpose of this study was to compare the outcomes of a hospital-based home-care model with those of a conventional outpatient follow-up for mentally ill patients in Taiwan by means of cost-effectiveness analysis. The study design was a two group post hoc design. We interviewed 40 mentally ill patients who were followed up in the psychiatric outpatient department. Another 40 mentally ill patients who participated in a hospital based home care program were also interviewed. The outcome measures we used for interviews were disease maintenance behavior, psychotic symptoms, social function, service satisfaction, and cost. The cost for each patient was the sum of costs for all direct mental health services. The cost-effectiveness ratio showed that the costs of the hospital-based home care model (4.3) were lower than those of conventional outpatient follow-up (13.5) and that over a one-year period, the hospital-based home care model was associated with improvements in mental conditions, social functional outcomes, and service satisfaction. The improved outcomes and the lower costs in the hospital-based home care program support the view that it is the most cost-effective of the two. Policy makers may consider this analysis as they allocate resources and develop policy for the care of mentally ill patients.

1. Accounting in Bureau of National Health Insurance(2004).National health insurance annual statistical report.
2. Andrews, G.,Issakidis, C.,Sanderson, K.,Corry, J.,Lapsley, H.(2004).Utilising survey data to inform public policy: Comparison of the cost-effectiveness of treatment of ten mental disorders.British Journal of Psychiatry,184,526-533.
3. Introduction of Bureau of National Health Insurance
4. Chan, S.,Mackenzie, A.,Jacobs, P.(2000).Cost-effectiveness analysis of case management versus a routine community care organization for patients with chronic schizophrenia.Archives of Psychiatric Nursing,14(2),96-104.
5. Chang, W. Y.,Henry, B. M.(1999).Methodological principles of cost analysis in the nursing, medical, and health services literature, 1990-1996.Nursing Research,48(2),94-104.
6. Chen, M. B.,Yin, J. C.,Tsai, S. L.(1999).Factors related unmet needs of community psychiatric patients in Taipei.Nursing Research,7(1),77-89.
7. Drummond, M. F.,O''Brien, B. J.,Stoddart, G. I.,Torrance, G. W.(1999).Methods for the economic evaluation of health care programmers.New York:Oxford.
8. Fenton, W. S.,Hoch, J. S.,Herrell, J. M.,Mosher L.,Dixon, L.(2002).Cost and cost-effectiveness of hospital vs residential crisis care for patients who have serious mental illness.Archives of General Psychiatry,59,357-364.
9. Gold, M. R.,Siegel, J. E.,Russell, L. B.,Weinstein, M. C.(1996).Cost-effectiveness in health and medicine.New York:Oxford.
10. Hwu, H. K.,Sun, M. C.,Chu, T. H.,Chang, M. T.(1987).The reliability and validity of the rating scales of community psychiatric care.Taiwanese Journal of Psychiatry,1(1),33-43.
11. Kampman, O.,Illi, A.,Poutanen, P.,Leinonen, E.(2003).Four-year outcome in non-compliant schizophrenia patients treated with or without home-based ambulatory outpatient care.European Psychiatry,18,1-5.
12. Kim, E. Y.,Yang, B. M.(2005).Cost-effectiveness of long-term care services in South Korea.Archives of Gerontology & Geriatrics,40(1),73-83.
13. Lieberman, H. J.(1992).High needs and low priority of mentally ill residents of adult homes.Hospital & Community Psychiatry,43(5),486-488.
14. Lin, C. L.,Yin, C. J.,Kuo, I. T.,Tsai, S. L.(2001).A comparison of effectiveness and cost between models of care for individuals with schizophrenia living in Taiwan.Archives of Psychiatric Nursing,15(6),272-278.
15. Mayo, T. L.(1997).Mental health services in the home: A balance of sophistication and caring.Home Healthcare Nurse,15(4),271-274.
16. Mohit, D. L.(1996).Management and care of mentally ill mothers of young children: An innovative program.Archives of Psychiatric Nursing,10(1),49-54.
17. Morris, M.(1996).Patients' perceptions of psychiatric home care.Archives of Psychiatric Nursing,10(3),76-183.
18. Pullen, I.,Kendrick, T.(1995).Peer commentaries on an evaluation of community-based psychiatric care for people with treated long-term mental illness.British Journal of Psychiatry,167(1),38-40.
19. Rothbard, A. B.,Metraux, S.,Blank, M. B.(2003).Cost of care for Medicaid recipients with serious mental illness and HIV infection or AIDS.Psychiatric Services,54(9),1240-1246.
20. Yang, Y. K.,Mou, H. S.,Chen, Y. C.,Hsu, C. C.(1991).The therapeutic effect of the outpatient department service and combining home care service in schizophrenia patients.Taiwanese Journal of Psychiatry,5(4),215-223.
21. Yeh, I. Q.(1987).Many problems of psychiatric services in our country.Chinese Journal of Mental Health,3(1),5-8.
22. Yeh, L. L.,Lee, Y. C.,Yang, M. C.(1997).The economic cost of the severely mentally ill patients.Chinese Journal of Mental Health,10(3),1-15.
23. Zhang, W. H.,Zhou, M. C.,Hu, H. M.(1994).The investigation of home care program of schizophrenia in a rural area.Journal of Clinical Psychiatry,4,96-97.

1. 許曉芬(2017)。精神科居家照護效益分析。義守大學醫務管理學系學位論文。2017。1-67。