de Jonge Peter, Bauer Iris, Huyse Frits J, Latour Corine H M
Department of Psychiatry, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Psychosom Med. 2003 Jul-Aug;65(4):534-41. doi: 10.1097/01.psy.0000077504.01963.1b.
To detect the patients in medical wards at risk of extended LOS and poor discharge health status with the use of complexity prediction instrument (COMPRI) and interdisciplinary medicine (INTERMED) instruments.
STUDY 1: In a sample of 275 consecutively admitted medical inpatients, a hierarchical cluster analysis on INTERMED variables was performed. The clusters were compared on length of hospital stay (LOS) and Short Form 36 (SF-36) at discharge. STUDY 2: Receiver operating characteristic (ROC) analysis was used to optimal cut-off points for the COMPRI and INTERMED. Patients detected with COMPRI and INTERMED were then compared with undetected patients on LOS and SF-36.
STUDY 1: In concordance with previous findings, a cluster of patients with high biopsychosocial vulnerability was identified with significantly higher scores on LOS (p <.05) and lower scores on SF-36 (p <.001) than patients in other clusters. STUDY 2: A cut-off point for the COMPRI of 5/6 was found to detect patients at risk of long LOS. A cut off score for the INTERMED of 20/21 was found to detect patients at risk of poor discharge health status. Patients detected with COMPRI and INTERMED had a significantly longer LOS (p <.001) and a poorer discharge health status (SF-36 MCS: p <.001; SF-36 PCS: p =.05) than nondetected patients. Of the detected patients, 37% had an extended hospital stay and poor discharge health status; of the nondetected patients, this was only 7%.
The COMPRI-INTERMED can help to detect complex patients admitted to medical wards within the first days of admission, and rule out those with a small chance of poor outcomes.
使用复杂性预测工具（COMPRI）和跨学科医学（INTERMED）工具，检测内科病房中存在住院时间延长和出院时健康状况不佳风险的患者。
研究1：在275例连续入院的内科住院患者样本中，对INTERMED变量进行分层聚类分析。比较各聚类在住院时间（LOS）和出院时简短健康调查问卷（SF-36）方面的差异。研究2：采用受试者工作特征（ROC）分析确定COMPRI和INTERMED的最佳截断点。然后将通过COMPRI和INTERMED检测出的患者与未检测出的患者在LOS和SF-36方面进行比较。
研究1：与先前的研究结果一致，识别出一组具有高生物心理社会脆弱性的患者，与其他聚类中的患者相比，该组患者的LOS得分显著更高（p<.05），SF-36得分更低（p<.001）。研究2：发现COMPRI的截断点为5/6时可检测出有住院时间延长风险的患者。发现INTERMED的截断分数为20/21时可检测出有出院时健康状况不佳风险的患者。与未检测出的患者相比，通过COMPRI和INTERMED检测出的患者住院时间显著更长（p<.001），出院时健康状况更差（SF-36精神健康分量表：p<.001；SF-36生理健康分量表：p=.05）。在检测出的患者中，37%的患者住院时间延长且出院时健康状况不佳；在未检测出的患者中，这一比例仅为7%。
COMPRI-INTERMED有助于在入院后的头几天内检测出内科病房收治的复杂患者，并排除那些预后不良可能性较小的患者。
