Geller J L, Fisher W H, McDermeit M, Brown J M
Department of psychiatry at the University of Massachusetts Medical School, Worcester 01655, USA.
Psychiatr Serv. 1998 Mar;49(3):327-32. doi: 10.1176/ps.49.3.327.
The study examined the characteristics of frequent users of inpatient treatment under public-sector managed care in Massachusetts between 1992 and 1995 and explored whether their pattern of inpatient utilization affected their overall use of hospital days.
Individuals with five or more admissions in any of four fiscal years (1992 to 1995) were identified using the Massachusetts Department of Mental Health client tracking system. The demographic and clinical characteristics of these patients and the types of hospitals they used were compared with those of all patients in case management programs who had a hospital admission but who did not meet study criteria for multiple admissions.
Compared with other patients, patients with multiple admissions were more likely to be young Caucasian females with personality disorder and a history of substance abuse but not a current substance use disorder. They tended to be lower functioning as measured by the Georgia Role Functioning Scale (GRFS) and to have higher levels of distress, as measured by the global personal distress portion of the GRFS. They made up 6 to 8 percent of all clients with a psychiatric admission who were enrolled in a case management program, but they accounted for 21 to 27 percent of all admissions in the four fiscal years. Patients with multiple admissions had significantly longer lengths of stay when admitted to a hospital where they had not been previously admitted in the past 12 months.
States setting up public-sector managed care or revising existing public-sector managed care contracts should ensure that subpopulations of persons at high risk for multiple admissions receive special attention. They should also create networks of inpatient providers to enable frequent users of acute care facilities to return to the same facility that previously discharged them.
本研究考察了1992年至1995年间马萨诸塞州公共部门管理式医疗下住院治疗频繁使用者的特征，并探讨了他们的住院利用模式是否影响其总体住院天数。
利用马萨诸塞州心理健康部的客户跟踪系统，确定在四个财政年度（1992年至1995年）中任何一年有五次或更多次住院记录的个体。将这些患者的人口统计学和临床特征以及他们所使用的医院类型，与病例管理项目中所有有过住院记录但不符合多次住院研究标准的患者进行比较。
与其他患者相比，多次住院的患者更有可能是年轻的白人女性，患有精神障碍且有药物滥用史，但目前没有药物使用障碍。以佐治亚角色功能量表（GRFS）衡量，他们的功能往往较低，而以GRFS的总体个人痛苦部分衡量，他们的痛苦程度较高。他们占参加病例管理项目的所有精神科住院患者的6%至8%，但在四个财政年度中占所有住院人数的21%至27%。在过去12个月内未曾住院的医院住院时，多次住院的患者住院时间明显更长。
建立公共部门管理式医疗或修订现有公共部门管理式医疗合同的州，应确保对多次住院高风险亚人群给予特别关注。他们还应建立住院服务提供者网络，使急性护理设施的频繁使用者能够回到之前将他们出院的同一设施。
