Hospital Medicine Section, Department of Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO 80220, USA.
J Hosp Med. 2013 Aug;8(8):450-5. doi: 10.1002/jhm.2044. Epub 2013 Apr 16.
Little is known about the contribution of psychiatric illness to medical 30-day readmission risk.
To determine the independent contribution of psychiatric illness and substance abuse to all-cause and potentially avoidable 30-day readmissions in medical patients.
Retrospective cohort study.
Patients discharged from the medicine services at a large teaching hospital from July 1, 2009 to June 30, 2010.
The main outcome of interest was 30-day all-cause and potentially avoidable readmissions; the latter determined by a validated algorithm (SQLape) in both bivariate and multivariate analysis. Readmissions were captured at 3 hospitals where the majority of these patients are readmitted.
Of 6987 discharged patients, 1260 were readmitted within 30 days (18.0%); 388 readmissions were potentially avoidable (5.6%). In multivariate analysis, 2 or more prescribed outpatient psychiatric medications (odds ratio [OR]: 1.1, 95% confidence interval [CI]: 1.01-1.20) or any prescription of anxiolytics (OR: 1.16, 95% CI: 1.00-1.35) were associated with increased all-cause readmissions, whereas discharge diagnoses of anxiety (OR: 0.82, 95% CI: 0.68-0.99) or substance abuse (OR: 0.80, 96% CI: 0.65-0.99) were associated with fewer all-cause readmissions. These findings were not replicated as predictors of potentially avoidable readmissions; rather, patients with discharge diagnoses of depression (OR: 1.49, 95% CI: 1.09-2.04) and schizophrenia (OR: 2.63, 95% CI: 1.13-6.13) were at highest risk.
Our data suggest that patients treated during a hospitalization for depression and for schizophrenia are at higher risk for potentially avoidable 30-day readmissions, whereas those prescribed more psychiatric medications as outpatients are at increased risk for all-cause readmissions. These populations may represent fruitful targets for interventions to reduce readmission risk.
对于精神疾病对医疗 30 天再入院风险的贡献，我们知之甚少。
确定精神疾病和物质滥用对所有原因和潜在可避免的 30 天内内科患者再入院的独立贡献。
回顾性队列研究。
2009 年 7 月 1 日至 2010 年 6 月 30 日期间，从一所大型教学医院的内科出院的患者。
主要观察结果是 30 天内所有原因和潜在可避免的再入院；后者通过验证算法（SQLape）在双变量和多变量分析中确定。在三家医院对再入院情况进行了跟踪，这些患者大部分都在这几家医院再入院。
在 6987 名出院患者中，1260 人在 30 天内再次入院（18.0%）；388 例再入院是潜在可避免的（5.6%）。多变量分析显示，2 种或以上规定的门诊精神科药物（比值比[OR]：1.1，95%置信区间[CI]：1.01-1.20）或任何阿普唑仑处方（OR：1.16，95%CI：1.00-1.35）与全因再入院增加相关，而焦虑（OR：0.82，95%CI：0.68-0.99）或物质滥用（OR：0.80，96%CI：0.65-0.99）的出院诊断与全因再入院减少相关。这些发现并不能作为潜在可避免的再入院的预测因素；相反，患有抑郁症（OR：1.49，95%CI：1.09-2.04）和精神分裂症（OR：2.63，95%CI：1.13-6.13）出院诊断的患者再入院的风险最高。
我们的数据表明，因抑郁症和精神分裂症住院治疗的患者，潜在可避免的 30 天内再入院的风险更高，而门诊规定更多精神科药物的患者，全因再入院的风险更高。这些人群可能是降低再入院风险的有效目标。
