Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, USA; Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, USA.
Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, USA.
Gen Hosp Psychiatry. 2021 Sep-Oct;72:7-14. doi: 10.1016/j.genhosppsych.2021.06.009. Epub 2021 Jun 26.
Irregular discharge is a concern among mental health populations and associated with poor outcomes. Little is known about the relationship between irregular discharge and treatment setting. Because care processes differ between acute inpatient and residential settings, it is important to evaluate irregular discharge in these settings.
A retrospective study was conducted in patients with mental health conditions admitted to acute inpatient or residential mental health settings in the Department of Veterans Affairs, 2003-2019. Logistic regression and multivariate Cox proportional hazards were used to evaluate factors associated with irregular discharge risk in the first 90- days of admission.
Among 1.8 million discharges, 7.4% had an irregular discharge within 90- days of admission. Younger age was a central predictor of risk. Irregular discharge rates were four-fold higher in residential versus acute settings. When accounting for length of stay (LOS) across settings, there was a modest higher risk of irregular discharge from acute versus residential settings (HR = 1.06, 95% Confidence Interval 1.04-1.07).
Patients are at high risk for irregular discharge from acute and residential settings when they are young. LOS is an important determinant of irregular discharge risk.. Interventions are needed to address drivers of irregular discharge.
精神健康人群中存在不规则出院的情况，这与不良结局相关。人们对不规则出院与治疗环境之间的关系知之甚少。由于急性住院和住院康复环境中的护理流程不同，因此评估这些环境中的不规则出院情况很重要。
本回顾性研究纳入了 2003 年至 2019 年期间在退伍军人事务部的急性住院或住院精神健康环境中接受治疗的精神健康状况患者。使用逻辑回归和多变量 Cox 比例风险评估了在入院后 90 天内不规则出院风险的相关因素。
在 180 万出院患者中，7.4%的患者在入院后 90 天内出现不规则出院。年龄较轻是风险的主要预测因素。与急性环境相比，住院环境的不规则出院率高出四倍。当考虑到跨环境的住院时间（LOS）时，与住院环境相比，急性环境的不规则出院风险略高（HR=1.06，95%置信区间 1.04-1.07）。
年轻患者在急性和住院环境中出院时，不规则出院的风险很高。LOS 是不规则出院风险的重要决定因素。需要采取干预措施来解决不规则出院的驱动因素。
