Running Bear Ursula, Anderson Heather, Manson Spero M, Shore Jay H, Prochazka Allan V, Novins Douglas K
University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America.
University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, 12850 E. Montview Blvd, Mail Stop C238, Aurora, CO 80045, United States of America.
Drug Alcohol Depend. 2014 Jul 1;140:168-74. doi: 10.1016/j.drugalcdep.2014.04.018. Epub 2014 Apr 28.
This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group.
We sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year.
Forty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR=.96, 95% CL=.94, .99, P=.002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status.
The GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare.
本研究在一批入住住院酒精戒断治疗的成年阿拉斯加原住民患者样本中，考察了与再次接受解毒治疗相关的预测因素。尽管已确诊患有酒精中毒的阿拉斯加原住民被认定为医疗保健系统的频繁使用者且死亡风险较高，但对于该群体再次接受解毒治疗的相关因素却知之甚少。
我们试图通过一项回顾性队列研究来预测再次入院情况。样本包括2006年至2007年期间入住住院解毒治疗单元并被诊断为酒精戒断的383名成年阿拉斯加原住民患者。采用Cox比例风险模型来估计一年内再次入院时间的未调整和调整后的关联。
42%的患者在一年内再次入院。入院时测量的全球功能评估（GAF；《精神疾病诊断与统计手册》[DSM-IV]多轴诊断系统中的轴V）得分与再次入院相关。GAF得分每增加1分（风险比=0.96，95%置信区间=0.94，0.99，P=0.002），再次入院率就会降低4%。结果还表明，GAF介导了再次入院与就业和住房状况之间的关系。
GAF既衡量疾病严重程度又衡量适应功能，是标准行为健康评估的一部分，且易于评分。通过制定临床方案，在解毒治疗及后续护理过程中考虑适应功能和疾病严重程度的差异，有可能降低再次入院率。
