School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China.
Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite, Atlanta, GA, 300, USA.
BMC Psychiatry. 2020 Mar 11;20(1):113. doi: 10.1186/s12888-020-02515-1.
Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China.
Data on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics.
The 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04-1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56-0.91) and frequent readmissions (OR 0.60, 95%CI 0.40-0.91).
More than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.
精神科住院患者的再入院会对患者及其家庭造成负面影响，同时增加医疗保健成本。本研究旨在调查与精神科患者入院后 30 天和 1 年内再入院相关的因素，并探索在中国监测和改善精神科医疗质量的可能性。
从中国北京 10 家二级和三级精神病院的住院病历数据库中提取索引入院、随后入院、临床和医院相关因素。使用逻辑回归来检查 30 天和 1 年再入院率以及频繁再入院（≥3 次/年）与临床变量以及医院特征之间的关联。
30 天和 1 年精神科再入院率分别为 16.69%（1289/7724）和 33.79%（2492/7374）。2492 例患者中有 746 例（29.34%）在一年内再次入院 3 次或以上（频繁再入院）。与 30 天和 1 年再入院风险显著相关的因素包括居住在城市地区、患有合并症、有精神科入院史、入院时的住院时间>60 天以及在三级医院接受治疗（p<0.001）。男性患者更有可能频繁再入院（OR 1.30，95%CI 1.04-1.64）。接受电抽搐治疗（ECT）与 30 天再入院（OR 0.72，95%CI 0.56-0.91）和频繁再入院（OR 0.60，95%CI 0.40-0.91）的风险降低显著相关。
超过 30%的精神科住院患者在 1 年内再次入院。城市居民、合并症患者、有精神科入院史或住院时间较长的患者更有可能再次入院，而男性更有可能频繁再入院。ECT 治疗可能降低 30 天再入院和频繁入院的可能性。应设计和试行有针对性的干预措施，以有效监测和减少精神科再入院。
