临床、治疗及医疗保健系统特征对青少年精神科再入院的影响。
The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.
作者信息
Fontanella Cynthia A
机构信息
College of Social Work, The Ohio State University, Columbus, OH 43210, USA.
出版信息
Am J Orthopsychiatry. 2008 Apr;78(2):187-98. doi: 10.1037/a0012557.
This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and the Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One-year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, postdischarge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes.
本研究对522名参加医疗补助计划并入住马里兰州三家住院精神病医院的青少年样本的再入院预测因素进行了调查。从档案来源（病历、医疗补助索赔和地区资源文件）收集了有关临床、治疗和医疗保健系统特征的综合数据。采用双变量（Kaplan Meier）和多变量（Cox回归）生存技术对再入院的预测因素进行了研究。一年再入院率为38%，大多数再入院情况发生在出院后3个月内。青少年人口统计学特征（年龄和性别）、临床特征（症状严重程度、合并症、自杀倾向）和家庭特征（家庭风险水平）与再入院有关。然而，包括后续护理类型、出院后生活环境、药物治疗不依从性和医院提供者在内的治疗因素是再入院的最强预测因素之一。研究结果强调了仔细的出院计划以及与适当后续护理建立联系的重要性。各医院不同的再入院率也表明，组织层面的因素可能在决定治疗结果方面发挥至关重要的作用。
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