Hamilton Jane E, Rhoades Howard, Galvez Juan, Allen Melissa, Green Charles, Aller Mildred, Soares Jair C
Department of Psychiatry, University of Texas Medical School at Houston, Houston, TX, USA.
University of Texas Harris County Psychiatric Center, Houston, TX, USA.
J Eval Clin Pract. 2015 Aug;21(4):572-8. doi: 10.1111/jep.12335. Epub 2015 Mar 10.
RATIONALE, AIMS AND OBJECTIVES: The rate of psychiatric readmissions within 30 days of discharge is a well-established behavioural health system performance measure linked to the quality of inpatient hospital care as well as to access to community-based aftercare services. The purpose of this study was to examine the factors differentially associated with earlier readmission among a sample of patients (n = 588) readmitted within 30 days of discharge to a university teaching psychiatric hospital from 2001 to 2010.
Quality assurance interviews were conducted with patients readmitted within 30 days of discharge. The interview data were merged with clinical symptom and electronic medical record data. Multinomial logistic regression analysis was used to examine readmission within 7 days and from 8 to 14 days compared with 15-30 days after discharge while controlling for socio-demographic and treatment variables previously associated with psychiatric readmission.
Multiple clinical, treatment and patient-reported factors were differentially associated with earlier readmission. In particular, lack of engagement in post-discharge aftercare services was a strong predictor of earlier readmission.
Strategies are needed to improve patients' transition from inpatient psychiatric hospitalization to aftercare services. Psychiatric hospitals attempting to reduce very early readmissions should seek to implement innovative transitional care initiatives targeting both patient and treatment factors.
原理、目的和目标：出院后30天内的精神科再入院率是一个既定的行为健康系统绩效指标，与住院医院护理质量以及获得社区后续护理服务有关。本研究的目的是调查2001年至2010年期间出院后30天内再次入住一所大学教学精神病医院的患者样本（n = 588）中，与早期再入院差异相关的因素。
对出院后30天内再次入院的患者进行质量保证访谈。访谈数据与临床症状和电子病历数据合并。采用多项逻辑回归分析，在控制先前与精神科再入院相关的社会人口统计学和治疗变量的同时，比较出院后7天内、8至14天内以及15至30天内的再入院情况。
多种临床、治疗和患者报告的因素与早期再入院存在差异相关。特别是，出院后缺乏参与后续护理服务是早期再入院的一个有力预测因素。
需要采取策略来改善患者从住院精神科治疗到后续护理服务的过渡。试图减少极早期再入院的精神病医院应寻求实施针对患者和治疗因素的创新过渡护理举措。
