Heo Jongho, Yoon Nan-He, Shin Soyoun, Yu Soo-Young, Lee Manwoo
National Assembly Futures Institute, National Assembly Member's Hall, 1, Uisadang-daero, Yeongdeungpo-gu, Seoul, 07233, Republic of Korea.
Division of Social Welfare and Health Administration, Wonkwang University, 460 Iksandae-ro, Iksan, 54538, Republic of Korea.
Int J Ment Health Syst. 2021 Oct 14;15(1):76. doi: 10.1186/s13033-021-00499-3.
High rates of involuntary hospitalization and long lengths of stay have been problematic in Korea. To address these problems, the Mental Health and Welfare Law was revised in 2016, mainly to protect patient rights by managing involuntary admissions. The aim of this study was to evaluate the impact of the revised Mental Health and Welfare Law on deinstitutionalization by using routinely collected data from hospital admissions and continuity of mental health service use after hospital discharge as proxy measures of deinstitutionalization.
We used monthly-aggregated claims-based data with a principal or secondary diagnosis of schizophrenia from 2012 to 2019, collected by the National Health Insurance Service. Outcome variables included rates of first admission; discharges; re-admissions within 7, 30, and 90 days; outpatient visits after discharge within 7 and 30 days; and continuity of visits, at least once a month for 6 months after discharge. Using interrupted time series analysis, we estimated the change in levels and trends of the rates after revision, controlling for baseline level and trend.
There was no significant change in first admission and discharge rates after the revision. Immediately after the revision, however, the rates of re-admission within 7 and 30 days dropped significantly, by 2.24% and 1.99%, respectively. The slopes of the re-admission rate decreased significantly, by 0.10% and 0.14%, respectively. The slopes of the re-admission rate within 90 days decreased (0.001%). The rates of outpatient visits within 7 and 30 days increased by 1.98% and 2.72%, respectively. The rate of continuous care showed an immediate 4.0% increase.
The revision had slight but significant effects on deinstitutionalization, especially decreasing short-term re-admission and increasing immediate outpatient service utilization.
在韩国，非自愿住院率高和住院时间长一直是问题。为解决这些问题，2016年修订了《精神健康与福利法》，主要通过管理非自愿入院来保护患者权利。本研究的目的是通过使用从医院入院常规收集的数据以及出院后精神卫生服务使用的连续性作为非机构化的替代指标，评估修订后的《精神健康与福利法》对非机构化的影响。
我们使用了2012年至2019年由国民健康保险服务机构收集的以精神分裂症为主诊断或次诊断的月度汇总索赔数据。结果变量包括首次入院率、出院率、7天、30天和90天内的再入院率、出院后7天和30天内的门诊就诊率以及出院后6个月内每月至少一次就诊的连续性。使用中断时间序列分析，我们估计了修订后率的水平和趋势变化，并控制了基线水平和趋势。
修订后首次入院率和出院率没有显著变化。然而，修订后立即出现的情况是，7天和30天内的再入院率分别显著下降了2.24%和1.99%。再入院率的斜率分别显著下降了0.10%和0.14%。90天内再入院率的斜率下降了（0.001%）。7天和30天内的门诊就诊率分别提高了1.98%和2.72%。持续护理率立即提高了4.0%。
修订对非机构化有轻微但显著影响，特别是减少了短期再入院并提高了即时门诊服务利用率。
