Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, Rotterdam, the Netherlands.
Zilveren Kruis Achmea, Department of Health Procurement, Leusden, the Netherlands.
PLoS One. 2018 Mar 13;13(3):e0194029. doi: 10.1371/journal.pone.0194029. eCollection 2018.
Hospital inpatients often experience medical and psychiatric problems simultaneously. Although this implies a certain relationship between healthcare utilization and costs, this relationship has never been systematically reviewed.
The objective is to examine the extent to which medical-psychiatric comorbidities relate to health-economic outcomes in general and in different subgroups. If the relationship is significant, this would give additional reasons to facilitate the search for targeted and effective treatments for this complex population.
A systematic review in Embase, Medline, Psycinfo, Cochrane, Web of Science and Google Scholar was performed up to August 2016 and included cross-references from included studies. Only peer-reviewed empirical studies examining the impact of inpatient medical-psychiatric comorbidities on three health-economic outcomes (length of stay (LOS), medical costs and rehospitalizations) were included. Study design was not an exclusion criterion, there were no restrictions on publication dates and patients included had to be over 18 years. The examined populations consisted of inpatients with medical-psychiatric comorbidities and controls. The controls were inpatients without a comorbid medical or psychiatric disorder. Non-English studies were excluded.
From electronic literature databases, 3165 extracted articles were scrutinized on the basis of title and abstract. This resulted in a full-text review of 86 articles: 52 unique studies were included. The review showed that the presence of medical-psychiatric comorbidity was related to increased LOS, higher medical costs and more rehospitalizations. The meta-analysis revealed that patients with comorbid depression had an increased mean LOS of 4.38 days compared to patients without comorbidity (95% CI: 3.07 to 5.68, I2 = 31%).
Medical-psychiatric comorbidity is related to increased LOS, medical costs and rehospitalization; this is also shown for specific subgroups. This study had some limitations; namely, that the studies were very heterogenetic and, in some cases, of poor quality in terms of risk of bias. Nevertheless, the findings remain valid and justify the search for targeted and effective interventions for this complex population.
住院患者经常同时患有医疗和精神疾病。尽管这意味着医疗保健的利用和成本之间存在一定的关系，但这种关系从未被系统地审查过。
目的是检查医疗-精神共病与一般人群和不同亚组的健康经济结果之间的关系程度。如果这种关系是显著的，这将为寻找针对这一复杂人群的有针对性和有效的治疗方法提供更多的理由。
对 Embase、Medline、Psycinfo、Cochrane、Web of Science 和 Google Scholar 进行了系统的综述，截至 2016 年 8 月，并纳入了来自纳入研究的交叉引用。仅包括研究住院患者医疗-精神共病对三种健康经济结果（住院时间（LOS）、医疗费用和再住院）影响的同行评审实证研究。研究设计不是排除标准，对出版物日期没有限制，纳入的患者必须年满 18 岁。检查的人群包括患有医疗-精神共病的住院患者和对照组。对照组为无共病医疗或精神障碍的住院患者。不包括非英语研究。
从电子文献数据库中，对标题和摘要进行了 3165 篇文章的筛选。在此基础上，对 86 篇文章进行了全文审查：52 项独特的研究被纳入。综述结果表明，存在医疗-精神共病与 LOS 增加、医疗费用增加和再住院率增加有关。荟萃分析显示，患有共病抑郁症的患者的平均 LOS 比无共病患者增加了 4.38 天（95%CI：3.07-5.68，I2=31%）。
医疗-精神共病与 LOS 增加、医疗费用增加和再住院有关；这也适用于特定的亚组。本研究存在一些局限性；即，研究非常异质，在某些情况下，其质量较差，存在偏倚风险。然而，研究结果仍然有效，证明了为这一复杂人群寻找有针对性和有效的干预措施的合理性。
