Lorine Kim, Goenjian Haig, Kim Soeun, Steinberg Alan M, Schmidt Kendall, Goenjian Armen K
*Collaborative Neuroscience Network, LLC, Garden Grove; †Harbor UCLA Medical Center, Torrance, CA; ‡University of Texas Health Science Center, Division of Biostatistics, Houston, TX; and §UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA.
J Nerv Ment Dis. 2015 Jun;203(6):425-30. doi: 10.1097/NMD.0000000000000305.
The present study focused on identifying risk factors for early readmission of patients discharged from an urban community hospital. Retrospective chart reviews were conducted on 207 consecutive inpatient psychiatric admissions that included patients who were readmitted within 15 days, within 3 to 6 months, and not admitted for at least 12 months post-discharge. Findings indicated that a diagnosis of schizophrenia/schizoaffective disorder (OR = 18; 95% CI 2.70-117.7; p < 0.05), history of alcohol abuse (OR = 9; 95% CI 1.80-40.60; p < 0.05), number of previous psychiatric hospitalizations (OR = 2; 95% CI 1.28-3.73; p < 0.05), and type of residence at initial admission (e.g., homeless, OR = 29; 95% CI 3.99-217; p < 0.05) were significant risk factors for early readmission, where OR compares readmission group 1 versus group 3 in the multinomial logistic regression. Initial positive urine drug screen, history of drug abuse or incarceration, and legal status at initial admission did not predict early readmission. Reducing the risk factors associated with psychiatric readmissions has the potential to lead to the identification and development of preventative intervention strategies that can significantly improve patient safety, quality of care, well-being, and contain health care expenditures.
本研究聚焦于确定城市社区医院出院患者早期再入院的风险因素。对207例连续的住院精神科入院病例进行了回顾性病历审查,这些病例包括在出院后15天内、3至6个月内再入院的患者,以及出院后至少12个月未再入院的患者。研究结果表明,精神分裂症/分裂情感性障碍诊断(比值比[OR]=18;95%置信区间[CI]2.70 - 117.7;p<0.05)、酒精滥用史(OR = 9;95%CI 1.80 - 40.60;p<0.05)、既往精神科住院次数(OR = 2;95%CI 1.28 - 3.73;p<0.05)以及首次入院时的居住类型(如无家可归,OR = 29;95%CI 3.99 - 217;p<0.05)是早期再入院的显著风险因素,其中在多项逻辑回归中OR比较的是再入院第1组与第3组。初始尿药筛查阳性、药物滥用或监禁史以及首次入院时的法律状态并不能预测早期再入院。降低与精神科再入院相关的风险因素有可能促使识别和制定预防性干预策略,从而显著提高患者安全、护理质量、幸福感,并控制医疗保健支出。