Heggestad Torhild, Greve Gottfried, Skilbrei Birger, Elgen Irene
Department of Research and Development, Haukeland University Hospital, Bergen, Norway.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Acta Paediatr. 2020 Dec;109(12):2641-2647. doi: 10.1111/apa.15250. Epub 2020 Apr 17.
To identify children with complex medical needs by examining their patterns of hospital care.
We conducted a retrospective population-based study on 18 577 patients aged 6-12 years from the Haukeland University Hospital register over a 3-year period (from 2013 to 2015). Data were structured to examine the temporal patterns and sequences of referrals, care episodes and diagnoses, including flow across medical specialties.
Over a third of patients had repeated referrals, and 14.9% of all had three or more. Furthermore, 9.3% of patients were referred to both somatic and mental healthcare services. Patients with such combined referrals had a higher number of referrals as well as a higher number of different diagnoses. Overall, there was a high frequency of non-specific diagnoses, and 34.8% of patients still had a non-specific main diagnosis at the end of their hospital contact.
This study demonstrates an increased risk for complex care pathways in children with multiple referrals. Interdisciplinary patterns of referrals were relatively common, particularly for patients in mental health care. These findings highlight the importance of developing interdisciplinary-based approaches for patients with complex complaints.
通过检查儿童的住院治疗模式来识别有复杂医疗需求的儿童。
我们对豪克兰大学医院登记册中18577名6至12岁的患者进行了一项为期3年（2013年至2015年）的基于人群的回顾性研究。数据经过整理，以检查转诊、护理事件和诊断的时间模式及顺序，包括各医学专科间的流程。
超过三分之一的患者有重复转诊，所有患者中有14.9%有三次或更多次转诊。此外，9.3%的患者同时被转诊至躯体和精神保健服务机构。此类联合转诊的患者转诊次数更多，诊断的种类也更多。总体而言，非特异性诊断的频率较高，34.8%的患者在住院治疗结束时仍有非特异性主要诊断。
本研究表明，多次转诊的儿童出现复杂护理路径的风险增加。跨学科转诊模式相对常见，尤其是在精神卫生保健患者中。这些发现凸显了为有复杂诉求的患者制定基于跨学科方法的重要性。
