Post-Discharge Hospital Utilization Among Adult Medical Inpatients With Depressive Symptoms
Post-Discharge Hospital Utilization Among Adult Medical Inpatients With Depressive Symptoms
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DOI：
10.1002/jhm.673
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发表时间：
2010-09-01
影响因子：
2.6
通讯作者：
Jack, Brian W.
中科院分区：
文献类型：
--
作者：
Mitchell, Suzanne E.;Paasche-Orlow, Michael K.;Jack, Brian W.
背景技术背景：几乎没有证据表明抑郁症是否能预测接受普通医疗服务的成年住院患者出院后的医院利用率。目的：我们旨在确定住院期间抑郁症筛查阳性是否与住院服务回报率增加显著相关。设计：使用来自Project RED随机对照试验的738名讲英语的住院成人的数据进行二次分析（clinicaltrials.gov标识符：NCT 00252057）。测量：我们使用九项患者健康问卷（PHQ-9）抑郁筛查工具来识别具有抑郁症状的患者。主要终点是医院利用率，定义为出院后30天内急诊科（艾德）就诊次数和再入院次数。Poisson回归被用来控制混杂variables.RESULTS：纳入分析的738例受试者中，238例（32%）筛选阳性抑郁症状。出院后30天内未校正的医院利用率为每100名抑郁症患者56次利用，而每100名非抑郁症患者30次利用，发病率比（IRR）（置信区间[CI]）为1.90（1.51-2.40）。在控制了潜在的混杂因素后，观察到有抑郁症状的患者出院后的医院利用率高于无抑郁症状的患者（IRR [CI]，1.73 [1.27-2.36]）。住院期间抑郁症状的阳性筛查与出院后30天内再入院率的增加相关，安全网医院人口。医院医学杂志2010; 5：378-384。(C)2010年医院医学会。
BACKGROUND: Little evidence exists to determine whether depression predicts hospital utilization following discharge among adult inpatients on a general medical service.OBJECTIVE: We aimed to determine whether a positive depression screen during hospitalization is significantly associated with an increased rate of returning for hospital services.DESIGN: A secondary analysis was performed using data from 738 English-speaking, hospitalized adults from the Project RED randomized controlled trial (clinicaltrials.gov Identifier: NCT00252057) conducted at an urban academic safety-net hospital.MEASUREMENTS: We used the nine-item Patient Health Questionnaire (PHQ-9) depression screening tool to identify patients with depressive symptoms. The primary endpoint was hospital utilization, defined as the number of emergency department (ED) visits plus readmissions within 30 days of discharge. Poisson regression was used to control for confounding variables.RESULTS: Of the 738 subjects included in the analysis, 238 (32%) screened positive for depressive symptoms. The unadjusted hospital utilization within 30 days of discharge was 56 utilizations per 100 depressed patients compared with 30 utilizations per 100 non-depressed patients, incident rate ratio (IRR) (confidence interval [CI]), 1.90 (1.51-2.40). After controlling for potential confounders, a higher rate of post-discharge hospital utilization was observed in patients with depressive symptoms compared to patients without depressive symptoms (IRR [CI], 1.73 [1.27-2.36]).CONCLUSIONS: A positive screen for depressive symptoms during an inpatient hospital stay is associated with an increased rate of readmission within 30 days of discharge in an urban, academic, safety-net hospital population. Journal of Hospital Medicine 2010; 5: 378-384. (C) 2010 Society of Hospital Medicine.