Medford-Davis Laura N, Shah Rohan, Kennedy Danielle, Becker Emilie
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX.
University of Pennsylvania, College of Arts and Sciences, Philadelphia, PA.
Med Care. 2018 Jan;56(1):31-38. doi: 10.1097/MLR.0000000000000845.
Preventable hospitalizations are markers of potentially low-value care. Addressing the problem requires understanding their contributing factors.
The objective of this study is to determine the correlation between specific mental health diseases and each potentially preventable hospitalization as defined by the Agency for Healthcare Research and Quality.
DESIGN/SUBJECTS: The Texas Inpatient Public Use Data File, an administrative database of all Texas hospital admissions, identified 7,351,476 adult acute care hospitalizations between 2005 and 2008.
A hierarchical multivariable logistic regression model clustered by admitting hospital adjusted for patient and hospital factors and admission date.
A total of 945,280 (12.9%) hospitalizations were potentially preventable, generating $6.3 billion in charges and 1.2 million hospital days per year. Mental health diseases [odds ratio (OR), 1.25; 95% confidence interval (CI), 1.22-1.27] and substance use disorders (OR, 1.13; 95% CI, 1.12-1.13) both increased odds that a hospitalization was potentially preventable. However, each mental health disease varied from increasing or decreasing the odds of potentially preventable hospitalization depending on which of the 12 preventable hospitalization diagnoses were examined. Older age (OR, 3.69; 95% CI, 3.66-3.72 for age above 75 years compared with 18-44 y), black race (OR 1.44; 95% CI, 1.43-1.45 compared to white), being uninsured (OR 1.52; 95% CI, 1.51-1.54) or dual-eligible for both Medicare and Medicaid (OR, 1.23; 95% CI, 1.22-1.24) compared with privately insured, and living in a low-income area (OR, 1.20; 95% CI, 1.17-1.23 for lowest income quartile compared with highest) were other patient factors associated with potentially preventable hospitalizations.
Better coordination of preventative care for mental health disease may decrease potentially preventable hospitalizations.
可预防的住院治疗是潜在低价值医疗的标志。解决这一问题需要了解其促成因素。
本研究的目的是确定特定心理健康疾病与医疗保健研究与质量局定义的每种潜在可预防住院治疗之间的相关性。
设计/研究对象：德克萨斯州住院患者公共使用数据文件是一个关于德克萨斯州所有医院入院情况的行政数据库，该数据库确定了2005年至2008年间7351476例成人急性护理住院病例。
采用分层多变量逻辑回归模型，按收治医院进行聚类，并对患者、医院因素和入院日期进行校正。
共有945280例（12.9%）住院治疗可能是可预防的，每年产生63亿美元的费用和120万个住院日。心理健康疾病[比值比（OR）为1.25；95%置信区间（CI）为1.22 - 1.27]和物质使用障碍（OR为1.13；95%CI为1.12 - 1.13）均增加了住院治疗可能可预防的几率。然而，根据所检查的12种可预防住院诊断中的哪一种，每种心理健康疾病在增加或降低潜在可预防住院几率方面有所不同。与18 - 44岁相比，75岁以上的老年人（OR为3.69；95%CI为3.66 - 3.72）、黑人种族（与白人相比，OR为1.44；95%CI为1.43 - 1.45）、未参保者（OR为1.52；95%CI为1.51 - 1.54）或同时符合医疗保险和医疗补助资格者（OR为1.23；95%CI为1.22 - 1.24）与私人参保者相比，以及生活在低收入地区（与最高收入四分位数相比，最低收入四分位数的OR为1.20；95%CI为1.17 - 1.23）是与潜在可预防住院治疗相关的其他患者因素。
更好地协调心理健康疾病的预防护理可能会减少潜在可预防的住院治疗。
