Leon S C, Uziel-Miller N D, Lyons J S, Tracy P
Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School, Chicago 60611, USA.
J Am Acad Child Adolesc Psychiatry. 1999 Mar;38(3):305-10. doi: 10.1097/00004583-199903000-00018.
To examine factors related to psychiatric hospitalization decision and length of stay of wards of the illinois Department of Child and Family Services.
A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI), a reliable, quantitative measure of psychiatric severity and its mediating factors. The CSPI was completed by hospital screeners upon conclusion of their crisis interviews. In addition to completing the CSPI, workers reported on demographic information, DSM-IV diagnoses, prescreening living arrangements, and length of hospital stay.
CSPI variables could effectively predict decision to admit versus deflect. The overall accuracy of this statistically significant prediction model was 77.9%, which was replicated on a new sample. Factors associated with decision to hospitalize are clinical in nature; ratings of suicidality, dangerousness, and impulsivity contributed the most to the model. Predicting length of stay was only moderately successful. Despite achieving significance, the model accounted for just 15.1% of length of stay variance using a multiple regression. Factors associated with length of stay were largely nonclinical in nature: living arrangement stability, region of the hospitalization, and age.
These results can be used to assess how decisions regarding level and duration of care are currently being made as a point of departure for quality improvement efforts.
研究与伊利诺伊州儿童与家庭服务部病房精神病住院决策及住院时长相关的因素。
采用前瞻性设计，运用儿童精神疾病严重程度量表（CSPI），这是一种对精神疾病严重程度及其中介因素进行可靠定量测量的工具。CSPI由医院筛查人员在危机访谈结束时完成。除完成CSPI外，工作人员还报告了人口统计学信息、DSM-IV诊断、预筛查生活安排及住院时长。
CSPI变量能够有效预测入院与转诊决策。这个具有统计学意义的预测模型的总体准确率为77.9%，该结果在一个新样本中得到了重复验证。与住院决策相关的因素本质上是临床性的；自杀倾向、危险性和冲动性评分对模型的贡献最大。预测住院时长仅取得了一定程度的成功。尽管具有统计学意义，但该模型在多元回归分析中仅解释了住院时长方差的15.1%。与住院时长相关的因素本质上大多是非临床性的：生活安排稳定性、住院地区和年龄。
这些结果可用于评估目前关于护理水平和时长的决策方式，作为质量改进工作的出发点。
