School of Health Sciences, Central Michigan University, Mount Pleasant, Michigan.
School of Health Sciences and Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University.
J Healthc Manag. 2023;68(3):198-214. doi: 10.1097/JHM-D-22-00115.
We explored how readmissions may result from patients' lack of access to aftercare services, failure to adhere to psychotropic medication plans, and inability to understand and follow hospital discharge recommendations. We also investigated whether insurance status, demographics, and socioeconomic status are associated with hospital readmissions. This study is important because readmissions contribute to increased personal and hospital expenses and decreased community tenure (the ability to maintain stability between hospital admissions). Addressing hospital readmissions will promote optimal discharge practices beginning on day one of hospital admission.
The study examined the differences in hospital readmission rates for patients with a primary psychotic disorder diagnosis. Discharge data were drawn in 2017 from the Nationwide Readmissions Database. Inclusion criteria included patients aged 0-89 years who were readmitted to a hospital between less than 24 hr and up to 30 days from discharge. Exclusion criteria were principal medical diagnoses, unplanned 30-day readmissions, and discharges against medical advice. The sampling frame included 269,906 weighted number of patients diagnosed with a psychotic disorder treated at one of 2,355 U.S. community hospitals. The sample size was 148,529 unweighted numbers of patients discharged.
In a logistic regression model, weighted variables were calculated and used to determine an association between the discharge dispositions and readmissions. After controlling for hospital characteristics and patient demographics, we found that the odds for readmission for routine and short-term hospital discharge dispositions decreased for home health care discharges, which indicated that home health care can prevent readmissions. The finding was statistically significant when controlling for payer type and patient age and gender.
The findings support home health care as an effective option for patients with severe psychosis. Home health care reduces readmissions and is recommended, when appropriate, as an aftercare service following inpatient hospitalization and may enhance the quality of patient care. Improving healthcare quality involves optimizing, streamlining, and promoting standardized processes in discharge planning and direct transitions to aftercare services.
我们探讨了患者无法获得后续护理服务、不遵守精神药物治疗计划以及无法理解和遵循出院建议可能导致再入院的原因。我们还调查了保险状况、人口统计学特征和社会经济地位是否与医院再入院有关。这项研究很重要，因为再入院会导致个人和医院费用增加，社区居住时间（在医院入院和出院之间保持稳定的能力）减少。解决医院再入院问题将促进从入院第一天开始实施最佳出院实践。
本研究考察了患有原发性精神病诊断的患者的医院再入院率差异。2017 年，从全国再入院数据库中提取出院数据。纳入标准包括年龄在 0-89 岁之间、出院后 24 小时内至 30 天内再次入院的患者。排除标准包括主要医疗诊断、计划外 30 天再入院和未经医嘱出院。抽样框架包括在 2355 家美国社区医院接受治疗的 269906 名患有精神病诊断的加权患者。样本量为 148529 名未加权的出院患者。
在逻辑回归模型中，计算了加权变量并用于确定出院处置与再入院之间的关联。在控制医院特征和患者人口统计学特征后，我们发现，对于常规和短期医院出院处置，家庭健康护理出院的再入院几率降低，这表明家庭健康护理可以预防再入院。在控制支付类型和患者年龄与性别后，这一发现具有统计学意义。
研究结果支持家庭健康护理作为严重精神病患者的有效选择。家庭健康护理可降低再入院率，在适当情况下，作为住院后后续护理服务，并可提高患者护理质量。提高医疗保健质量涉及优化、简化和促进出院计划和直接过渡到后续护理服务的标准化流程。
