Boaz Timothy L, Becker Marion Ann, Andel Ross, Van Dorn Richard A, Choi Jiyoon, Sikirica Mirko
Psychiatr Serv. 2013 Dec 1;64(12):1225-9. doi: 10.1176/appi.ps.003382012.
OBJECTIVE The study examined risk factors for readmission to acute care among Florida Medicaid enrollees with schizophrenia treated with antipsychotics. METHODS Medicaid and service use data for 2004 to 2008 were used to identify adults with schizophrenia discharged from hospitals and crisis units who were taking antipsychotics. Data were extracted on demographic characteristics, service use before admission, psychopharmacologic treatment after discharge, and readmission to acute behavioral health care. Cox proportional hazards regression estimated readmission risk in the 30 days after discharge and in the period after 30 days for participants not readmitted in the first 30 days. RESULTS The mean±SD age of the 3,563 participants was 43.4±11.1; 61% were male, and 38% were white. Participants had 6,633 inpatient episodes; duration of hospitalization was 10.6±7.0 days. Readmission occurred for 84% of episodes, 23% within 30 days. Variables associated with an increased readmission risk in the first 30 days were shorter hospitalization (hazard ratio [HR]=1.18, 95% confidence interval [CI]=1.10-1.27, p<.001), shorter time on medication before discharge (HR=1.19, CI=1.06-1.35, p=.003), greater prehospitalization use of acute care (HR=2.64, CI=2.29-3.05, p<.001), serious general medical comorbidity (HR=1.21, CI=1.06-1.38, p=.005), and prior substance abuse treatment (HR=1.58, CI=1.37-1.83, p<.001). After 30 days, hospitalization duration and time on medication were not significant risk factors. CONCLUSIONS Short hospital stays for persons with schizophrenia may be associated with risk of early readmission, possibly because the person is insufficiently stabilized. More chronic risk factors include prior acute care, general medical comorbidity, and substance abuse.
目的 本研究调查了接受抗精神病药物治疗的佛罗里达州医疗补助计划中精神分裂症患者再次入住急症护理的风险因素。方法 利用2004年至2008年的医疗补助计划和服务使用数据，确定从医院和危机干预机构出院且正在服用抗精神病药物的成年精神分裂症患者。提取了有关人口统计学特征、入院前服务使用情况、出院后精神药物治疗情况以及再次入住急性行为健康护理机构的数据。Cox比例风险回归估计了出院后30天内以及前30天未再次入院的参与者在30天后的再次入院风险。结果 3563名参与者的平均年龄±标准差为43.4±11.1岁；61%为男性，38%为白人。参与者有6633次住院发作；住院时间为10.6±7.0天。84%的发作出现了再次入院情况，23%在30天内。与前30天内再次入院风险增加相关的变量包括住院时间较短（风险比[HR]=1.18，95%置信区间[CI]=1.10 - 1.27，p<0.001）、出院前用药时间较短（HR=1.19，CI=1.06 - 1.35，p=0.003）、入院前更多地使用急症护理（HR=2.64，CI=2.29 - 3.05，p<0.001）、严重的一般医疗合并症（HR=1.21，CI=1.06 - 1.38，p=0.005）以及既往有药物滥用治疗史（HR=1.58，CI=1.37 - 1.83，p<0.001）。30天后，住院时间和用药时间不是显著的风险因素。结论 精神分裂症患者住院时间短可能与早期再次入院风险相关，可能是因为患者病情未得到充分稳定。更多的慢性风险因素包括既往急症护理、一般医疗合并症和药物滥用。
