HABITUALLY WANDERING PATIENTS
HABITUALLY WANDERING PATIENTS
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DOI：
10.1056/nejm199412293312606
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发表时间：
1994-12-29
影响因子：
158.5
通讯作者：
JACKSON, J
中科院分区：
文献类型：
--
作者：
PANKRATZ, L;JACKSON, J
背景资料。医生有时要面对一家又一家医院入院的病人，有时也被称为“流浪病人”。对这些患者的主要症状、医院资源利用情况、医疗费用等知之甚少，我们分析了退伍军人事务部医疗中心(VAMCS)服务的流浪患者的人口学和临床特征。对于他们收治的每一名患者，退伍军人事务部医疗系统中的所有159家医院都将人口统计和诊断信息提交给德克萨斯州奥斯汀数据处理中心的中央数据库，我们搜索这些记录以确定从1988财年到1992财年每年入住四家或更多VAMC的患者。结果，在任何一年发现的患者被称为“流浪者”；在所有五年中被发现的患者被称为“习惯性流浪者”。1988年，我们确定了1013名流浪者。这一数字每年逐渐下降到1992年的729人，1991年有810名流浪患者，他们平均每年大约8次入院和100多天的住院治疗；他们在当年的住院和门诊费用中约占2650万美元。从1988年到1992年的五年里，只有35名患者四处游荡。这35名男性中最常见的出院诊断与药物滥用(主要是酒精中毒)和精神障碍有关。他们的2268次住院和7832次门诊在五年期间估计花费了650万美元。反复入住不同医院的患者--游荡的患者--积累了大量的入院人数，导致诊断混乱，并接受不协调的治疗。由于其疾病的复杂性，这类患者需要在区域或国家基础上进行病例管理。
Background. Physicians are sometimes confronted with patients who gain admission to one hospital after another, sometimes referred to as ''wandering patients.'' Little is known about the presenting symptoms of these patients, their use of hospital resources, or the costs of their medical care, We analyzed the demographic and clinical characteristics of wandering patients served by Department of Veterans Affairs medical centers (VAMCs),Methods. For each patient they admit, all 159 hospitals in the Veterans Affairs medical system submit demographic and diagnostic information to a central data base at the Data Processing Center in Austin, Texas, We searched these records to identify patients who were admitted to four or more VAMCs within each year from fiscal year 1988 through 1992. Patients so identified in any one year were called ''wanderers''; those identified in all five years were designated ''habitual wanderers,Results. We identified 1013 wanderers in 1988. The number gradually declined each year to 729 in 1992, In 1991 there were 810 wandering patients, who averaged about eight admissions per year and more than 100 days of inpatient care; they accounted for about $26.5 million in costs for inpatient and outpatient care in that year. Only 35 patients wandered in all five years from 1988 through 1992. The most common discharge diagnoses of these 35 men were related to substance abuse (mostly alcoholism) and mental disorders. Their 2268 admissions and 7832 outpatient visits cost an estimated $6.5 million over the five-year period.Conclusions. Patients who are repeatedly admitted to different hospitals - wandering patients - accumulate high numbers of admissions, cause diagnostic confusion, and receive uncoordinated care. Because of the complexity of their disorders, such patients require case management on a regional or national basis.