Ajmera Mayank, Wilkins Tricia Lee, Findley Patricia A, Sambamoorthi Usha
Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA.
Int J Family Med. 2012;2012:823294. doi: 10.1155/2012/823294. Epub 2012 Dec 20.
Background. Individuals with multimorbidity are vulnerable to poor quality of care due to issues related to care coordination. Ambulatory care sensitive hospitalizations (ACSHs) are widely accepted quality indicators because they can be avoided by timely, appropriate, and high-quality outpatient care. Objective. To examine the association between multimorbidity, mental illness, and ACSH. Study Design. We used a longitudinal panel design with data from multiple years (2000-2005) of Medicare Current Beneficiary Survey. Individuals were categorized into three groups: (1) multimorbidity with mental illness (MM/MI); (2) MM/no MI; (3) no MM. Multivariable logistic regressions were used to analyze the association between multimorbidity and ACSH. Results. Any ACSH rates varied from 10.8% in MM/MI group to 8.8% in MM/No MI group. Likelihood of any ACSH was higher among beneficiaries with MM/MI (AOR = 1.62; 95% CI = 1.14, 2.30) and MM (AOR = 1.54; 95% CI = 1.12, 2.11) compared to beneficiaries without multimorbidity. There was no statistically significant difference in likelihood of ACSH between MM/MI and MM/No MI groups. Conclusion. Multimorbidity (with or without MI) had an independent and significant association with any ACSH. However, presence of mental illness alone was not associated with poor quality of care as measured by ACSH.
背景。患有多种疾病的个体由于护理协调问题而容易受到护理质量差的影响。门诊护理敏感型住院（ACSH）是被广泛认可的质量指标，因为通过及时、适当和高质量的门诊护理可以避免此类住院情况。目的。研究多种疾病、精神疾病与ACSH之间的关联。研究设计。我们采用了纵向面板设计，使用了来自医疗保险当前受益人调查多年（2000 - 2005年）的数据。个体被分为三组：（1）患有精神疾病的多种疾病（MM/MI）；（2）多种疾病/无精神疾病；（3）无多种疾病。使用多变量逻辑回归分析多种疾病与ACSH之间的关联。结果。任何ACSH发生率在MM/MI组为10.8%，在MM/无MI组为8.8%。与没有多种疾病的受益人相比，MM/MI组（AOR = 1.62；95% CI = 1.14，2.30）和多种疾病组（AOR = 1.54；95% CI = 1.12，2.11）的受益人发生任何ACSH的可能性更高。MM/MI组和MM/无MI组之间ACSH发生可能性没有统计学上的显著差异。结论。多种疾病（无论有无精神疾病）与任何ACSH都存在独立且显著的关联。然而，仅精神疾病的存在与以ACSH衡量的护理质量差并无关联。
