Assuntos
Proteção da Criança/legislação & jurisprudência , Cuidados no Lar de Adoção/legislação & jurisprudência , Lares para Grupos/legislação & jurisprudência , Adolescente , Criança , Saúde da Criança , Proteção da Criança/economia , Aconselhamento , Educação não Profissionalizante/economia , Educação não Profissionalizante/legislação & jurisprudência , Cuidados no Lar de Adoção/economia , Lares para Grupos/economia , Humanos , Saúde Mental , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Estados Unidos , Adulto JovemAssuntos
Centros Comunitários de Saúde Mental/economia , Lares para Grupos/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Transtornos Mentais/economia , Adulto , Idoso , Análise de Variância , Estudos de Coortes , Análise Custo-Benefício , Bases de Dados Factuais , Feminino , Habitação , Humanos , Masculino , Transtornos Mentais/terapia , Michigan , Pessoa de Meia-Idade , População UrbanaRESUMO
OBJECTIVES: To investigate whether a value of information analysis, commonly applied in health care evaluations, is feasible and meaningful in the field of crime prevention. METHODS: Interventions aimed at reducing juvenile delinquency are increasingly being evaluated according to their cost-effectiveness. Results of cost-effectiveness models are subject to uncertainty in their cost and effect estimates. Further research can reduce that parameter uncertainty. The value of such further research can be estimated using a value of information analysis, as illustrated in the current study. We built upon an earlier published cost-effectiveness model that demonstrated the comparison of two interventions aimed at reducing juvenile delinquency. Outcomes were presented as costs per criminal activity free year. RESULTS: At a societal willingness-to-pay of 71,700 per criminal activity free year, further research to eliminate parameter uncertainty was valued at 176 million. Therefore, in this illustrative analysis, the value of information analysis determined that society should be willing to spend a maximum of 176 million in reducing decision uncertainty in the cost-effectiveness of the two interventions. Moreover, the results suggest that reducing uncertainty in some specific model parameters might be more valuable than in others. CONCLUSIONS: Using a value of information framework to assess the value of conducting further research in the field of crime prevention proved to be feasible. The results were meaningful and can be interpreted according to health care evaluation studies. This analysis can be helpful in justifying additional research funds to further inform the reimbursement decision in regard to interventions for juvenile delinquents.
Assuntos
Crime/prevenção & controle , Teoria da Decisão , Delinquência Juvenil/prevenção & controle , Modelos Econômicos , Avaliação de Programas e Projetos de Saúde/economia , Adolescente , Criança , Comportamento do Consumidor , Análise Custo-Benefício , Custos e Análise de Custo , Crime/economia , Terapia Familiar/economia , Terapia Familiar/organização & administração , Estudos de Viabilidade , Lares para Grupos/economia , Lares para Grupos/organização & administração , Humanos , Delinquência Juvenil/economia , Cadeias de Markov , Países Baixos , Política Pública , Valores Sociais , Processos Estocásticos , IncertezaRESUMO
OBJECTIVES: This study was performed to assess the economic effect of interventions affecting transitions between dementia care settings in Germany. METHODS: A Markov-model that models the course of dementia with respect to typical care setting transitions was derived. Model data and parameters were retrieved by literature reviews. A deterministic and probabilistic sensitivity analysis was conducted to account for parameter uncertainty. RESULTS: In the base case, the expected present value of remaining lifetime costs is 25,326 for each cohort member. As a function of effectiveness, pharmaceutical interventions may reduce the costs by 2% to 13% and psychosocial interventions come with savings of 1% to 10%. A structural intervention-promoting group living as a substitute for nursing home care increases costs by 2% to 8%. Sensitivity analyses indicate high variance and variability of results, as well as valuation of informal care being a crucial parameter. CONCLUSIONS: There are economic benefits of delayed transitions to institutional settings, especially from the viewpoint of statutory care insurances, but these do unlikely exceed intervention costs. Thus, further intervention effects should be considered. Ultimately, concentrating research on preventive and protective factors of dementia could lead to an efficient intervention from every perspective.
Assuntos
Continuidade da Assistência ao Paciente/economia , Demência/economia , Lares para Grupos/economia , Serviços de Assistência Domiciliar/economia , Cadeias de Markov , Casas de Saúde/economia , Estudos de Coortes , Continuidade da Assistência ao Paciente/tendências , Demência/diagnóstico , Demência/epidemiologia , Lares para Grupos/tendências , Serviços de Assistência Domiciliar/tendências , Humanos , Mortalidade/tendências , Casas de Saúde/tendênciasRESUMO
This paper presents the findings of an exploratory research study of foster care youth residing in group homes in a mid-Atlantic state in the USA. The aims of the present study were to (1) describe youth characteristics, (2) explore whether baseline functioning differed by gender or ethnicity, (3) explore predictors of cross-time differences in psychosocial functioning, and (4) explore predictors of later functioning, specifically age, gender, and length of stay. Psychosocial functioning at two time points (i.e., T1 = admission into group home; T2 = current or discharge) in 180 charts from 29 randomly selected group homes were reviewed. Youth were on average 14.86 years of age, predominantly male (71%; n = 128), and predominantly African American (79%). Findings suggest that group home placement may benefit some youth but not others, particularly girls and younger children with lower initial level of need. Findings underscore the potential complexity of intervention impact in the context of unique youth, family, and environment factors.
Assuntos
Proteção da Criança , Lares para Grupos/organização & administração , Delinquência Juvenil , Transtornos Mentais/terapia , Adolescente , Sintomas Afetivos/economia , Sintomas Afetivos/terapia , Negro ou Afro-Americano/estatística & dados numéricos , Distribuição por Idade , Criança , Transtornos do Comportamento Infantil/economia , Transtornos do Comportamento Infantil/terapia , Pré-Escolar , Feminino , Lares para Grupos/economia , Lares para Grupos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Transtornos Mentais/economia , Mid-Atlantic Region , Avaliação de Programas e Projetos de Saúde/métodos , Análise de Regressão , Estudos Retrospectivos , Distribuição por Sexo , População Branca/estatística & dados numéricos , Adulto JovemAssuntos
Lares para Grupos/métodos , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Financiamento Governamental/economia , Lares para Grupos/economia , Lares para Grupos/normas , Educação em Saúde/métodos , Pessoal de Saúde/educação , Humanos , Pesquisa , Estigma SocialAssuntos
Educação/organização & administração , Lares para Grupos/organização & administração , Jovens em Situação de Rua , Apoio Social , Adolescente , Criança , Educação/economia , Obtenção de Fundos , Lares para Grupos/economia , Jovens em Situação de Rua/psicologia , Humanos , Londres , Estigma Social , Adulto JovemRESUMO
BACKGROUND: Increased provision of out-of-family residential support is required because of demographic changes within the intellectual disabilities population. Residential support now has to be provided in a climate requiring both financial constraint and high quality service outcomes. The aim was to evaluate the quality of life consequences of living with less intensive staff support, resulting from the introduction of more targeted staff allocation coupled with telecare. METHODS: The study comprised 91 participants who lived in 33 settings. The targeted support/telecare intervention was implemented at staggered intervals in 25 of these settings (63 participants). Data on a range of participant and setting descriptors, quality of care, and a range of objective lifestyle indicators were collected at four points in time over 2 years. Impact of the intervention was evaluated using within-group comparisons over time. RESULTS: Comparison between pre- and post-intervention showed that staffing levels were significantly reduced by 23%, whereas they were constant in the absence of intervention. One health indicator improved in the absence of intervention and another improved following intervention. There were no significant changes in any other lifestyle indicators (safety, money, social and community activity, independence or choice). CONCLUSIONS: A combination of targeted support and telecare had no adverse short-term affect on participants' quality of life, but reduced staff input so it seems that they have a role to play in the strategic development of out-of-family placements for adults with intellectual disabilities. Further research is needed to explore in more detail how efficiency is achieved in practice.
Assuntos
Cuidadores/organização & administração , Lares para Grupos/organização & administração , Estilo de Vida , Pessoas com Deficiência Mental/reabilitação , Telemedicina/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Feminino , Seguimentos , Lares para Grupos/economia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Telemedicina/economia , Telemedicina/instrumentação , Recursos Humanos , Adulto JovemRESUMO
We used data from a randomized controlled study of Oxford House (OH), a self-run, self-supporting recovery home, to conduct a cost-benefit analysis of the program. Following substance abuse treatment, individuals that were assigned to an OH condition (n=68) were compared to individuals assigned to a usual care condition (n=61). Economic cost measures were derived from length of stay at an Oxford House residence, and derived from self-reported measures of inpatient and outpatient treatment utilization. Economic benefit measures were derived from self-reported information on monthly income, days participating in illegal activities, binary responses of alcohol and drug use, and incarceration. Results suggest that OH compared quite favorably to usual care: the net benefit of an OH stay was estimated to be roughly $29,000 per person on average. Bootstrapped standard errors suggested that the net benefit was statistically significant. Costs were incrementally higher under OH, but the benefits in terms of reduced illegal activity, incarceration and substance use substantially outweighed the costs. The positive net benefit for Oxford House is primarily driven by a large difference in illegal activity between OH and usual care participants. Using sensitivity analyses, under more conservative assumptions we still arrived at a net benefit favorable to OH of $17,830 per person.
Assuntos
Continuidade da Assistência ao Paciente/economia , Redução de Custos , Lares para Grupos/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Serviços de Saúde Comunitária/organização & administração , Intervalos de Confiança , Continuidade da Assistência ao Paciente/organização & administração , Análise Custo-Benefício , Feminino , Lares para Grupos/organização & administração , Humanos , Tempo de Internação/economia , Sensibilidade e Especificidade , Meio Social , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/organização & administração , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: In this observational study indicators for the quality of psychiatric care in a psychiatric hostel will be examined for all residents over a period of 7 years. METHODS: Data has been collected at an annual basis. Relationships among variables have been analysed by means of random effects regression analyses for longitudinal data. RESULTS: GAF score increases slightly. Number of psychopharmacological drugs and neuroleptics as well as inpatient costs remains stable. Psychiatric treatment costs are negatively related to the functional level, residents' age and the duration of stay in the residential facility. Even under control of several variables, variance of total costs was found to be mainly explained by the costs of inpatient and psychopharmacological treatment. DISCUSSION: Increase of the general functional level indicates a positive development of autonomy. Changes and the influence factors of psychopharmacological treatment may indicate a need-oriented drug therapy. Some findings may indicate an institutionalisation process and an increasing of medical conditions in chronically mentally ill people.
Assuntos
Lares para Grupos/economia , Casas para Recuperação/economia , Hospitais Privados/economia , Hospitais Psiquiátricos/economia , Transtornos Mentais/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/uso terapêutico , Doença Crônica , Análise Custo-Benefício , Desinstitucionalização/economia , Feminino , Alemanha , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Vida Independente , Tempo de Internação/economia , Assistência de Longa Duração/economia , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Psicotrópicos/uso terapêutico , Garantia da Qualidade dos Cuidados de Saúde/economia , Ajustamento Social , Adulto JovemRESUMO
The Wicking project developed and evaluated a specialized model of residential care to support a group of older people living with alcohol-related brain injury (ARBI) and challenging behavior. The aim of the project was to determine the effectiveness of this model at improving participant life quality and well-being.
Assuntos
Alcoolismo/complicações , Lesões Encefálicas/reabilitação , Lares para Grupos/economia , Pessoas Mal Alojadas , Idoso , Lesões Encefálicas/etiologia , Custos e Análise de Custo , Atenção à Saúde/economia , Nível de Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Apoio SocialRESUMO
In May 2008, the Japanese government launched the 'Emergency Project for Improvement of Medical Care and Quality of Life for People with Dementia' under the idea that it is necessary to build a society, without delay, where people can live life safely without anxiety even after being affected by dementia, where they can be supported by appropriate and integrated services of medical care, long-term care and community care. We would like to introduce our future dementia policy standing on the outcome of this project, which was published as a report on 10 July 2008. The measures for people with dementia in Japan have gradually achieved good results. For example, public understanding and awareness of dementia has increased through renaming the term for dementia in Japanese from 'Chiho' to 'Ninchi-sho' in 2004, and the comprehensive care system was founded focusing on the importance of providing community based long-term care while maintaining the person's familiar human relationships and residential circumstances. However, case reports show that there are yet some cases that fail to deliver appropriate treatment or long-term care service as a result of a lack of timely definite diagnosis in an early stage or a lack of coordination between medical care and long-term care. Therefore, the future dementia policy should be designed by envisaging the flow of the measures that would support the life of the person and his/her family, and improve their quality of life; starting with measures that link early notice of the patient, his/her family or neighbor to early diagnosis, and then measures to develop well-designed comprehensive care planning that provides appropriate medical and long-term care services through good coordination, while promoting research and development of diagnosis/treatment technology. In addition, in regard to early-onset dementia, comprehensive self-support measures including employment assistance should be promoted.
Assuntos
Serviços de Saúde Comunitária/legislação & jurisprudência , Serviços de Saúde Comunitária/tendências , Demência/terapia , Política de Saúde/legislação & jurisprudência , Assistência de Longa Duração/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/métodos , Assistência Integral à Saúde/economia , Assistência Integral à Saúde/legislação & jurisprudência , Assistência Integral à Saúde/métodos , Demência/diagnóstico , Demência/economia , Diagnóstico Precoce , Previsões , Lares para Grupos/economia , Lares para Grupos/legislação & jurisprudência , Política de Saúde/economia , Humanos , Seguro de Assistência de Longo Prazo/economia , Seguro de Assistência de Longo Prazo/legislação & jurisprudência , Japão , Assistência de Longa Duração/economia , Programas Nacionais de Saúde/tendências , Qualidade de Vida/legislação & jurisprudênciaAssuntos
Serviços Comunitários de Saúde Mental/tendências , Desinstitucionalização/tendências , Vida Independente/psicologia , Pessoas com Deficiência Mental/reabilitação , Qualidade de Vida/psicologia , Características de Residência , Serviços Comunitários de Saúde Mental/economia , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Análise Custo-Benefício , Comparação Transcultural , Desinstitucionalização/economia , Desinstitucionalização/legislação & jurisprudência , Avaliação da Deficiência , Europa (Continente) , Lares para Grupos/economia , Lares para Grupos/legislação & jurisprudência , Lares para Grupos/tendências , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Vida Independente/economia , Vida Independente/legislação & jurisprudência , Estilo de Vida , Avaliação de Processos e Resultados em Cuidados de Saúde , Pessoas com Deficiência Mental/psicologia , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/legislação & jurisprudência , Qualidade de Vida/legislação & jurisprudência , Ajustamento Social , Transtornos do Comportamento Social/psicologia , Transtornos do Comportamento Social/reabilitação , Estados UnidosRESUMO
This experiment compared the effectiveness of an unlocked, mental health consumer-managed, crisis residential program (CRP) to a locked, inpatient psychiatric facility (LIPF) for adults civilly committed for severe psychiatric problems. Following screening and informed consent, participants (n = 393) were randomized to the CRP or the LIPF and interviewed at baseline and at 30-day, 6-month, and 1-year post admission. Outcomes were costs, level of functioning, psychiatric symptoms, self-esteem, enrichment, and service satisfaction. Treatment outcomes were compared using hierarchical linear models. Participants in the CRP experienced significantly greater improvement on interviewer-rated and self-reported psychopathology than did participants in the LIPF condition; service satisfaction was dramatically higher in the CRP condition. CRP-style facilities are a viable alternative to psychiatric hospitalization for many individuals facing civil commitment.
Assuntos
Associações de Consumidores , Intervenção em Crise , Serviços de Emergência Psiquiátrica , Lares para Grupos , Transtornos Mentais/terapia , Atividades Cotidianas , Adulto , California , Internação Compulsória de Doente Mental , Associações de Consumidores/economia , Serviços de Emergência Psiquiátrica/economia , Feminino , Lares para Grupos/economia , Custos de Cuidados de Saúde , Humanos , Modelos Lineares , Masculino , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Readmissão do Paciente , Satisfação do Paciente , AutoimagemRESUMO
In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes, and costs. There were no differences in the majority of lifestyle outcome measures. Fully staffed participants had better outcomes in money management and some health indicators. Semi-independent living participants had better outcomes for choice and community activities undertaken without staff support. Costs for semi-independent living were less. On balance, semi-independent living could offer certain cost-effective lifestyle advantages provided that sufficient attention is given to health, living, and financial well-being.
Assuntos
Atividades Cotidianas , Serviços Comunitários de Saúde Mental/economia , Lares para Grupos/economia , Deficiência Intelectual/economia , Estilo de Vida , Qualidade de Vida/psicologia , Atividades Cotidianas/psicologia , Adulto , Comportamento do Consumidor , Análise Custo-Benefício , Hospital Dia/economia , Inglaterra , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Deficiência Intelectual/psicologia , Deficiência Intelectual/reabilitação , Masculino , Análise por Pareamento , Avaliação de Processos e Resultados em Cuidados de Saúde , Ajustamento Social , Meio Social , Apoio Social , País de GalesRESUMO
Research on the merits of long-term group residences is inconclusive. The purpose of the present paper was to investigate the effects of supported group residence on the symptoms, social function, quality of life, general health quality, and the medical/psychiatric cost in Japan of a large number of psychiatric beds and long average length of stay. Patients were assessed every 6 months for 2 years using Positive and Negative Syndrome Scale, Katz Adjustment Scale, World Health Organization Quality of Life (WHO-QOL) and General Health Questionnaire 12-item version. Patients discharged to the supported group residence (SGR) significantly improved with regard to positive symptoms, the level of socially expected activities and free-time activities. The QOL physical domain of the inpatients was significantly more deteriorated compared to the SGR group. The total psychiatric/medical cost of the SGR group was approximately one-third that of the inpatient group, while the cost of the SGR to treat physical comorbidity was much higher. The present findings indicate that SGR has advantages for mental and social function but not for physical health. A major limitation of the present study was the high mean age (>60 years) of the subjects who had been hospitalized for a long period (mean, 24 years).
Assuntos
Lares para Grupos , Assistência de Longa Duração , Esquizofrenia/reabilitação , Atividades Cotidianas/psicologia , Adulto , Idoso , Análise Custo-Benefício , Feminino , Lares para Grupos/economia , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Hospitalização/economia , Hospitais Psiquiátricos/economia , Humanos , Japão , Assistência de Longa Duração/economia , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Esquizofrenia/diagnóstico , Esquizofrenia/economia , Psicologia do Esquizofrênico , Ajustamento Social , Revisão da Utilização de Recursos de SaúdeRESUMO
Costs of providing psychosocial rehabilitation services are analyzed using data from clubhouse programs in 12 countries. We explored effects of several program operating characteristics on total program cost per year, cost per member per year, and cost per visit. We also examined the relationship between program costs and the range of services offered. Clubhouse costs were found to be a function of the country in which the program was located, program age, and certification status. The number of specific services offered was not related to cost. Findings provide a more complete understanding of the operations and expenses of clubhouses.