急性精神病住院患者再入院与患者报告指标之间的关联：一项多中心前瞻性纵向研究。
Associations between readmission and patient-reported measures in acute psychiatric inpatients: a multicenter prospective longitudinal study.
作者信息
Yamaguchi Sosei, Ojio Yasutaka, Koike Junko, Matsunaga Asami, Ogawa Makoto, Kikuchi Akiko, Kawashima Takahiro, Tachimori Hisateru, Bernick Peter, Kimura Hiroshi, Inagaki Ataru, Watanabe Hiroyuki, Kishi Yoshiki, Yoshida Koji, Hirooka Takaaki, Oishi Satoru, Matsuda Yasuhiro, Fujii Chiyo
机构信息
Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan.
Department of Mental Health and Psychiatric Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
Soc Psychiatry Psychiatr Epidemiol. 2025 Jan;60(1):79-93. doi: 10.1007/s00127-024-02710-5. Epub 2024 Aug 5.
PURPOSE
This study examined whether patient-reported measures (PRMs) addressing quality of life, personal agency, functional impairment, and treatment satisfaction at hospital discharge were associated with future readmission during a 12-month follow-up period. The study also examined whether readmission influenced changes in the same measures.
METHODS
A multicenter prospective cohort study was conducted at 21 psychiatric hospitals in Japan. Participants completed the EuroQol-five-dimensions-five-level (EQ-5D), the Five-item Subjective Personal Agency Scale, and the Sheehan Disability Scale (SDS) at the time of index admission (T1), discharge from index admission (T2), and 6 months (T3) and 12 months (T4) after discharge. Inpatient treatment satisfaction was assessed at T2. Readmission and variables potentially associated with hospitalization and PRMs were evaluated using mixed-effects logistic regression models and mixed models for repeated measures.
RESULTS
A total of 491 participants were followed for 12 months (attrition rate: 19.4%), and 480 were included in the EQ-5D analysis. The most common diagnoses were schizophrenia (59%), depression (14%), and bipolar disorder (13%). No patient-reported measures were significantly associated with readmission over the follow-up period. Interaction of readmission and time did not significantly affect changes in EQ-5D. Readmission did significantly influence SDS score changes between T2 and T3 (B = 1.78, 95% CI = 0.30-3.25, p = 0.018) and between T3 and T4 (B = 1.43, 95% CI = 0.14-2.72, p = 0.029). The same influence of readmission on SDS score changes was not observed in the model which adjusted for all potential covariates.
CONCLUSION
Readmission was potentially associated with changes in self-reported functional impairment. Findings highlight the potential role of intensive post-discharge services in preventing readmission, rather than relying on time-of-discharge PRMs in order to predict readmission risk.
TRIAL REGISTRATION
This study was registered in UMIN Clinical Trials Registry (UMIN000034220).
目的
本研究探讨了在出院时患者报告的生活质量、个人能动性、功能障碍及治疗满意度等指标是否与12个月随访期内的再次入院相关。该研究还探讨了再次入院是否会影响这些指标的变化。
方法
在日本的21家精神病医院进行了一项多中心前瞻性队列研究。参与者在首次入院时（T1）、首次入院出院时（T2）、出院后6个月（T3）和12个月（T4）完成了欧洲五维健康量表（EQ-5D）、五项主观个人能动性量表以及希恩残疾量表（SDS）。在T2时评估住院治疗满意度。使用混合效应逻辑回归模型和重复测量混合模型评估再次入院情况以及可能与住院和患者报告指标相关的变量。
结果
共有491名参与者接受了12个月的随访（失访率：19.4%），480名被纳入EQ-5D分析。最常见的诊断为精神分裂症（59%）、抑郁症（14%）和双相情感障碍（13%）。在随访期内，没有患者报告的指标与再次入院显著相关。再次入院与时间的交互作用并未显著影响EQ-5D的变化。再次入院确实显著影响了T2和T3之间（B = 1.78，95%置信区间 = 0.30 - 3.25，p = 0.018）以及T3和T4之间（B = 1.43，95%置信区间 = 0.14 - 2.72，p = 0.029）的SDS评分变化。在对所有潜在协变量进行调整的模型中，未观察到再次入院对SDS评分变化有相同影响。
结论
再次入院可能与自我报告的功能障碍变化相关。研究结果突出了出院后强化服务在预防再次入院方面的潜在作用，而不是依赖出院时的患者报告指标来预测再次入院风险。
试验注册
本研究已在日本大学医学信息网络临床试验注册中心注册（UMIN000034220）。
Zotero 插件