老年医疗保险受益人的住院精神科治疗。

Inpatient psychiatric treatment of elderly Medicare beneficiaries.

作者信息

Ettner S L, Hermann R C

机构信息

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.

出版信息

Psychiatr Serv. 1998 Sep;49(9):1173-9. doi: 10.1176/ps.49.9.1173.

DOI:10.1176/ps.49.9.1173

PMID:9735958

Abstract

OBJECTIVE

The clinical characteristics and treatment patterns of elderly Medicare beneficiaries hospitalized for psychiatric disorders were examined.

METHODS

Administrative data on all elderly Medicare beneficiaries in the United States hospitalized in a nonfederal hospital for a primary psychiatric disorder in 1990-1991 were used to calculate descriptive statistics on case-mix by age group, hospital type (psychiatric hospital, general hospital psychiatric unit, or general hospital nonpsychiatric unit), and primary diagnosis. Length of stay, costs, and discharge destination by hospital type and primary diagnosis were also determined.

RESULTS

A total of .6 percent of elderly Medicare beneficiaries were hospitalized for a psychiatric disorder in 1990, accounting for more than 240,000 admissions and $1 billion in Medicare payments. The most common reasons for hospitalization were major depressive disorder (28.1 percent), dementia and other organic disorders (26.8 percent), and substance-related disorders (12.6 percent). Organic disorders were particularly prevalent among the oldest old, accounting for more than half of psychiatric admissions among those 85 and older. A total of 43 percent of the psychiatric admissions were to general hospital nonpsychiatric units, 38 percent to general hospital psychiatric units, and only 19 percent to psychiatric hospitals. Within each diagnostic category, patients admitted to general hospital nonpsychiatric units had the shortest average lengths of stay and the lowest average costs. Among beneficiaries with organic, affective, and psychotic disorders other than schizophrenia, those admitted to general hospitals had shorter lengths of stay, higher rates of discharge to nursing homes, and lower rates of discharge to self-care than those treated in psychiatric hospitals.

CONCLUSIONS

Case-mix-adjusted treatment patterns varied substantially across hospital types, due to differences in either illness severity or treatment styles.

摘要

目的

研究因精神疾病住院的老年医疗保险受益人的临床特征及治疗模式。

方法

利用1990 - 1991年在美国非联邦医院因原发性精神疾病住院的所有老年医疗保险受益人的行政数据，计算按年龄组、医院类型（精神病医院、综合医院精神科或综合医院非精神科）及主要诊断分类的病例组合描述性统计数据。还确定了按医院类型和主要诊断划分的住院时间、费用及出院去向。

结果

1990年，共有0.6%的老年医疗保险受益人因精神疾病住院，入院人数超过24万，医疗保险支付金额达10亿美元。住院的最常见原因是重度抑郁症（28.1%）、痴呆及其他器质性疾病（26.8%）和物质相关疾病（12.6%）。器质性疾病在高龄老人中尤为普遍，在85岁及以上老人的精神科入院病例中占一半以上。精神科入院病例中，43%入住综合医院非精神科，38%入住综合医院精神科，仅19%入住精神病医院。在每个诊断类别中，入住综合医院非精神科的患者平均住院时间最短，平均费用最低。在患有除精神分裂症外的器质性、情感性和精神病性疾病的受益人中，入住综合医院的患者住院时间较短，入住疗养院的出院率较高，自理出院率低于在精神病医院接受治疗的患者。