家庭参与精神科住院治疗：与出院计划和及时随访护理的关联。
Family Involvement in Psychiatric Hospitalizations: Associations With Discharge Planning and Prompt Follow-Up Care.
机构信息
New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider).
出版信息
Psychiatr Serv. 2019 Oct 1;70(10):860-866. doi: 10.1176/appi.ps.201900028. Epub 2019 Jul 16.
OBJECTIVE
Involving family in the care of inpatients with serious mental illness is known to be beneficial. This study examined frequencies of involvement by family in the care and discharge planning for 179 psychiatric inpatients.
METHODS
Involvement by family in care and discharge planning was assessed from randomly selected medical records of inpatients with Medicaid and severe mental illness at two New York hospitals from 2012 to 2013. "Family" also included anyone close to the patient who provided support. Medicaid claims were reviewed for patient demographic and clinical characteristics and for postdischarge outpatient attendance data. Multiple regression models were used to test whether involvement by family was associated with comprehensive discharge planning (contacting outpatient providers, scheduling follow-up appointments, and forwarding a discharge summary to a provider) and initiation of outpatient treatment.
RESULTS
Inpatient staff contacted a family member for 134 (75%) patients. Sixty-seven (37%) patients received comprehensive discharge planning, and 96 (53%) and 139 (78%) attended an outpatient appointment within 7 and 30 days of discharge, respectively. Inpatient staff contacting family, communicating about the patient's health and/or mental health, and communicating about the discharge plan were significantly associated with entry into follow-up care by 7 and 30 days postdischarge. Family phone calls and/or visits with patients, attendance at family therapy sessions, and communication with inpatient staff about services available to families were significantly associated with patients receiving comprehensive discharge planning. When analyses controlled for demographic and clinical factors, having any involvement between family members and inpatient staff was significantly associated with patients' attending an outpatient appointment by 7 days (odds ratio [OR]=2.79, 95% confidence interval [CI]=1.28-6.08) or 30 days (OR=3.07, 95% CI=1.29-7.32) after discharge.
CONCLUSIONS
The association of family involvement with comprehensive discharge planning and prompt entry into outpatient care underscores the importance of family contact and communication with staff during inpatient hospitalizations.
目的
让家庭成员参与严重精神疾病住院患者的治疗已被证明是有益的。本研究调查了 179 名精神科住院患者的家庭成员在护理和出院计划中的参与频率。
方法
2012 年至 2013 年，从纽约两家医院的 Medicaid 和严重精神疾病住院患者的随机病历中评估了家庭成员在护理和出院计划中的参与情况。“家庭成员”还包括与患者关系密切并提供支持的任何人。审查 Medicaid 索赔以获取患者的人口统计学和临床特征以及出院后门诊就诊数据。使用多元回归模型来检验家庭成员的参与是否与全面的出院计划（联系门诊提供者、安排随访预约和向提供者转发出院小结）和开始门诊治疗相关。
结果
住院工作人员联系了 134 名（75%）患者的家庭成员。有 67 名（37%）患者接受了全面的出院计划，分别有 96 名（53%）和 139 名（78%）在出院后 7 天和 30 天内预约了门诊就诊。住院工作人员与家庭成员联系、沟通患者的健康和/或心理健康状况以及沟通出院计划与 7 天和 30 天的随访护理开始显著相关。家庭成员与患者的电话交流和/或探访、参加家庭治疗会议以及与住院工作人员沟通家庭可获得的服务与患者接受全面的出院计划显著相关。当分析控制了人口统计学和临床因素时，家庭成员与住院工作人员之间的任何互动都与患者在出院后 7 天（优势比[OR]=2.79，95%置信区间[CI]=1.28-6.08）或 30 天（OR=3.07，95% CI=1.29-7.32）时预约门诊就诊显著相关。
结论
家庭成员的参与与全面的出院计划和及时进入门诊护理之间的关联强调了在住院期间与工作人员进行家庭联系和沟通的重要性。
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