San Thinn Daw San, Kuswanto Carissa Nadia, Sum Min Yi, Chai Suet Bin, Doris Sok Hian Koh, Xu Changqing, Chuan Su Alex Hsin, Sengupta Somnath, Jacob Rajesh, Sim Kang
Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum).
Prim Care Companion CNS Disord. 2015 Jul 16;17(4). doi: 10.4088/PCC.15m01789. eCollection 2015.
We examined health care utilization, clinical profiles (such as sociodemographic features, clinical severity), and outcomes (inpatient admission, revisit within 24 hours of discharge) of patients who were admitted to a 23-hour observation unit within the emergency service of a tertiary psychiatric hospital and hypothesized that a specific clinical profile (greater clinical severity, lower psychosocial functioning) predicted subsequent inpatient hospitalization.
The medical records of all patients admitted to the observation unit from February 5, 2007, to February 4, 2012 (N = 2,158) were assessed for relevant data. Clinical severity and level of psychosocial functioning were assessed using Clinical Global Impressions-Severity (CGI-S) and Global Assessment of Functioning (GAF) scales, respectively.
Overall, the patients seen were predominantly Chinese males > 36 years old who had diagnoses including stress-related, anxiety, affective spectrum, and psychotic disorders. The clinical severity score (CGI-S) improved significantly following discharge from the observation unit (t 1,1848 = 23.316; P < .001). Logistic regression analyses revealed that self-referred (P = .001), older patients (P = .007) with past psychiatric history (P = .019), lower GAF scores (P = .025), and less improvement of CGI-S scores (P = .001) were associated with inpatient admission after a 23-hour stay in the observation unit.
Our study findings affirmed our hypothesis and supported the utility of the observation unit in monitoring the overall clinical status of patients, which was linked with subsequent inpatient admissions. Better management of these patients at the outpatient level can potentially decrease unnecessary hospitalization and reduce health care cost as well as illness burden on patients and caregivers.
我们研究了在一家三级精神病医院急诊部的23小时观察病房住院的患者的医疗服务利用情况、临床特征(如社会人口学特征、临床严重程度)及结局(住院、出院后24小时内复诊),并假设特定的临床特征(更高的临床严重程度、更低的心理社会功能)可预测随后的住院治疗情况。
对2007年2月5日至2012年2月4日期间入住观察病房的所有患者(N = 2158)的病历进行相关数据评估。分别使用临床总体印象-严重程度(CGI-S)量表和功能总体评定量表(GAF)评估临床严重程度和心理社会功能水平。
总体而言,所观察的患者主要为36岁以上的中国男性,诊断包括与应激相关、焦虑、情感谱系及精神障碍。从观察病房出院后,临床严重程度评分(CGI-S)显著改善(t1,1848 = 23.316;P <.001)。逻辑回归分析显示,自行转诊(P =.001)、有既往精神病史(P =.019)、GAF评分较低(P =.025)、CGI-S评分改善较少(P =.001)的老年患者(P =.007)在观察病房停留23小时后与住院治疗相关。
我们的研究结果证实了我们的假设,并支持观察病房在监测患者总体临床状况方面的作用,这与随后的住院治疗相关。在门诊层面更好地管理这些患者可能会减少不必要的住院治疗,降低医疗成本以及患者和照顾者的疾病负担。