Risk factors for early unplanned readmission in patients with bipolar disorder: A retrospective observational study
Risk factors for early unplanned readmission in patients with bipolar disorder: A retrospective observational study
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DOI：
10.1016/j.genhosppsych.2019.03.003
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发表时间：
2019-05-01
影响因子：
7
通讯作者：
Fushimi, Kiyohide
中科院分区：
文献类型：
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作者：
Shinjo, Daisuke;Tachimori, Hisateru;Fushimi, Kiyohide
目的：缺乏关于患者、医院和地区因素与双相情感障碍患者早期意外再入院（短期结果）之间关系的证据。本研究旨在探讨与双相情感障碍患者早期非计划再入院相关的危险因素。方法：回顾性分析日本诊断程序组合数据库中2012年4月至2014年3月的成人双相情感障碍患者（ICD-10; F31）。我们使用多变量logistic回归分析检查了影响30天非计划再入院的因素。结果：共纳入2688例精神科住院患者。多因素分析显示，出院结果不变或加重（调整优势比[aOR]: 1.93； 95%可信区间[CI]: 1.06-3.51, p = 0.031）、非计划或紧急入院环境（aOR: 1.51; 95% CI: 1.00-2.26, p = 0.048）、身体共病（慢性肺部疾病）（aOR: 4.74; 95% CI: 1.30-17.29, p = 0.018）、精神科急症护理床位的存在（aOR: 1.72; 95% CI: 1.02-2.87, p = 0.040）、中等水平医院精神科人员配备(aOR: 1.82；95% CI: 1.14-2.91, p = 0.012)与较高的早期非计划再入院率显著相关，而该地区精神科医生密度较高（aOR: 0.50; 95% CI: 0.29-0.87, p = 0.014）与较低的早期非计划再入院率显著相关。结论：研究结果提示，要降低双相情感障碍患者的早期非计划再入院率，不仅需要对高危患者进行精心管理，还需要在精神科住院护理中考虑功能分化、精神科资源分配以及对双相情感障碍患者的随访支持。
Objectives: Evidence regarding the relationships between patient, hospital, and regional factors and early unplanned readmission (short-term outcome) in patients with bipolar disorder is lacking. This study aimed to examine risk factors associated with early unplanned readmission in patients with bipolar disorder.Method: We retrospectively analyzed adult bipolar patients (ICD-10; F31) between April 2012 and March 2014 in the Japanese Diagnosis Procedure Combination database. We examined factors affecting the 30-day unplanned readmission using multivariable logistic regression analysis.Results: A total of 2688 patients admitted to psychiatric beds were included. Multivariate analysis showed that unchanged or exacerbation discharge outcome (adjusted odds ratio [aOR]: 1.93; 95% confidence interval [CI]: 1.06-3.51, p = 0.031), unplanned or urgent admission settings (aOR: 1.51; 95% CI: 1.00-2.26, p = 0.048), physical comorbidity (chronic pulmonary disease) (aOR: 4.74; 95% CI: 1.30-17.29, p = 0.018), presence of psychiatric acute-care beds (aOR: 1.72; 95% CI: 1.02-2.87, p = 0.040), and intermediate-level hospital psychiatric staffing (aOR: 1.82; 95% CI: 1.14-2.91, p = 0.012) were significantly associated with higher early unplanned readmission, while higher density of psychiatrists in the area (aOR: 0.50; 95% CI: 0.29-0.87, p = 0.014) was significantly associated with lower early unplanned readmission.Conclusions: The results suggest that not only careful management of high-risk patients but also consideration of functional differentiation in psychiatric inpatient care, psychiatric resource allocation, and follow-up support for patients with bipolar disorder are needed for reducing the early unplanned readmission rate.