首次精神科住院后的急诊科就诊及再入院情况：一项数据关联研究
Emergency department presentation and readmission after index psychiatric admission: a data linkage study.
作者信息
Li Xue, Srasuebkul Preeyaporn, Reppermund Simone, Trollor Julian
机构信息
Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
出版信息
BMJ Open. 2018 Feb 28;8(2):e018613. doi: 10.1136/bmjopen-2017-018613.
OBJECTIVE
To use linked administrative datasets to assess factors associated with emergency department (ED) presentation and psychiatric readmission in three distinctive time intervals after the index psychiatric admission.
DESIGN
A retrospective data-linkage study.
SETTING
Cohort study using four linked government minimum datasets including acute hospital care from July 2005 to June 2012 in New South Wales, Australia.
PARTICIPANTS
People who were alive and aged ≥18 years on 1 July 2005 and who had their index admission to a psychiatric ward from 1 July 2007 to 30 June 2010.
OUTCOME MEASURES
ORs of factors associated with psychiatric admission and ED presentation were calculated for three intervals: 0-1 month, 2-5 months and 6-24 months after index separation.
RESULTS
Index admission was identified in 35 056 individuals (51% -males) with a median age of 42 years. A total of 12 826 (37%) individuals had at least one ED presentation in the 24 months after index admission. Of those, 3608 (28%) presented within 0-1 month, 6350 (50%) within 2-5 months and 10 294 (80%) within 6-24 months after index admission. A total of 14 153 (40%) individuals had at least one psychiatric readmission in the first 24 months. Of those, 6808 (48%) were admitted within 0-1 month, 6433 (45%) within 2-5 months and 7649 (54%) within 6-24 months after index admission. Principal diagnoses and length of stay at index admission, sociodemographic factors, Charlson Comorbidity Index score, drug and alcohol comorbidity, intellectual disability and other inpatient service use were significantly associated with ED presentations and psychiatric readmissions, and these relationships varied somewhat over the intervals studied.
CONCLUSION
Social determinants of service use, drug and alcohol intervention, addressing needs of individuals with intellectual disability and recovery-oriented whole-person approaches at index admission are key areas for investment to improve trajectories after index admission.
目的
利用关联的管理数据集，评估在首次精神科住院后的三个不同时间段内，与急诊科就诊及精神科再入院相关的因素。
设计
一项回顾性数据关联研究。
背景
队列研究，使用四个关联的政府最低数据集，涵盖2005年7月至2012年6月澳大利亚新南威尔士州的急性医院护理情况。
参与者
2005年7月1日时年龄≥18岁且在2007年7月1日至2010年6月30日期间首次入住精神科病房的存活者。
观察指标
计算在首次出院后的三个时间段（0 - 1个月、2 - 5个月和6 - 24个月）内，与精神科住院及急诊科就诊相关因素的比值比。
结果
共识别出35056名首次住院患者（51%为男性），中位年龄为42岁。在首次住院后的24个月内，共有12826名（37%）患者至少有一次急诊科就诊。其中，3608名（28%）在首次住院后0 - 1个月内就诊，6350名（50%）在2 - 5个月内就诊，10294名（80%）在6 - 24个月内就诊。在最初的24个月内，共有14153名（40%）患者至少有一次精神科再入院。其中，6808名（48%）在首次住院后0 - 1个月内再入院，6433名（45%）在2 - 5个月内再入院，7649名（54%）在6 - 24个月内再入院。主要诊断、首次住院的住院时长、社会人口学因素、查尔森合并症指数评分、药物和酒精合并症、智力残疾以及其他住院服务使用情况与急诊科就诊和精神科再入院显著相关，且这些关系在研究的时间段内略有不同。
结论
服务利用的社会决定因素、药物和酒精干预、满足智力残疾患者的需求以及在首次住院时采用以康复为导向的全人方法，是改善首次住院后病程轨迹的关键投资领域。
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