Barruel David, Perozziello Anne, Lefèvre Hassina, Msellati Annie, Launay Corine, Dauriac-Le Masson Valérie
Groupement Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France.
Front Psychiatry. 2024 Sep 18;15:1463415. doi: 10.3389/fpsyt.2024.1463415. eCollection 2024.
Shortening the length of hospital stay (LOS) has become a major challenge for psychiatric hospitals in reducing unnecessary costs and improving the patient healthcare experience. We investigated the key factors associated with a long psychiatric hospitalization.
This was a retrospective study of 8,870 full-time psychiatric hospital stays (6,216 patients) in the Paris Psychiatry Hospital Group, with a discharge in 2022. We used machine learning tools and univariate and multivariate methods to explore the impact of demographic, pathway-related, and clinical variables on the LOS.
LOS >30 days was associated with age >55 years {odds ratio [OR] =2 [95% confidence interval 1.7-2.3]}, admission from outside the sectorization zone [OR=1.2 (1.1-1.3)], admission via a psychiatric emergency unit [OR, 1.2 (1.1-1.4)], and some clinical severity markers, such as psychotic disorder diagnosis [OR, 1.5 (1.3-1.7)], mandatory care [request of a third party, OR, 2.5 (2.1-2.9); case of imminent danger, OR, 2.3 (1.9-2.7)], the presence of seclusion and mechanical restraint measures (highlighting the positive effect of restraint duration), the somatic comorbidity for female sex [OR, 1.4 (1.2-1.7)], and treatment resistance [OR, 1.4 (1.2-1.6)]. Conversely, LOS ≤30 days was associated with being in a relationship [OR, 0.6 (0.5-0.8)], admission during a travel-related psychiatric episode [OR, 0.5 (0.3-0.6)], and personality and behavior disorders [OR, 0.7 (0.6-0.9)]. We found no significant association for features such as sex and a lack of treatment compliance.
To our knowledge, this is the first recent study to investigate and highlight the impact of factors related to various illness severity markers, medication adherence, and patient journeys on the length of psychiatric hospital stay. A better understanding of long-stay risk factors might be helpful for optimizing the allocation of medical resources and anticipating tailored therapeutic programs.
缩短住院时间已成为精神病医院在降低不必要成本和改善患者医疗体验方面的一项重大挑战。我们调查了与长期精神科住院相关的关键因素。
这是一项对巴黎精神病医院集团2022年出院的8870例全日制精神科住院病例（6216名患者）的回顾性研究。我们使用机器学习工具以及单变量和多变量方法来探究人口统计学、病程相关和临床变量对住院时间的影响。
住院时间>30天与年龄>55岁相关{比值比[OR]=2[95%置信区间1.7 - 2.3]}，来自分区区域外的入院[OR = 1.2(1.1 - 1.3)]，通过精神科急诊入院[OR，1.2(1.1 - 1.4)]，以及一些临床严重程度指标，如精神障碍诊断[OR，1.5(1.3 - 1.7)]，强制治疗[第三方请求，OR，2.5(2.1 - 2.9)；存在迫在眉睫的危险情况，OR，2.3(1.9 - 2.7)]，存在隔离和机械约束措施（突出约束持续时间的积极影响），女性的躯体合并症[OR，1.4(1.2 - 1.7)]，以及治疗抵抗[OR，1.4(1.2 - 1.6)]。相反，住院时间≤30天与处于恋爱关系中[OR，0.6(0.5 - 0.8)]、与旅行相关的精神科发作期间入院[OR，0.5(0.3 - 0.6)]以及人格和行为障碍[OR，0.7(0.6 - 0.9)]相关。我们发现性别和缺乏治疗依从性等特征无显著关联。
据我们所知，这是近期第一项调查并突出各种疾病严重程度指标、药物依从性和患者病程相关因素对精神科住院时间影响的研究。更好地了解长期住院风险因素可能有助于优化医疗资源分配并制定量身定制的治疗方案。
