Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis.
Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis.
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DOI：
10.1097/adm.0b013e318231de51
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发表时间：
2012-03
影响因子：
5.5
通讯作者：
Jack BW
中科院分区：
文献类型：
--
作者：
Walley AY;Paasche-Orlow M;Lee EC;Forsythe S;Chetty VK;Mitchell S;Jack BW
出院可能是对物质使用障碍患者进行干预的机会，以减少随后的住院使用率。本研究确定物质使用障碍诊断是否与随后的急性护理医院使用率相关。我们进行了一项观察性队列研究，其中738名患者在城市，学术，安全网医院的一般医疗服务。主要结局为出院后30天内急症住院率和风险（急诊科就诊或住院）。主要自变量是在指数住院时是否存在物质使用障碍的主要或次要出院诊断代码。出院时，17%的受试者被诊断为物质使用障碍。与未诊断为物质使用障碍的患者相比，这些患者的复发性急症住院率更高（30天时0.63 vs 0.32, P < 0.01），任何复发性急症住院的风险增加（30天时33% vs 22%， P < 0.05）。在调整后的泊松回归模型中，诊断为物质使用障碍的患者与未诊断为物质使用障碍的患者相比，30天的发生率比为1.49（95%可信区间为1.12-1.98）。在亚组分析中，较高的使用率可归因于那些有药物诊断或药物和酒精联合诊断的人，而不是那些完全有酒精诊断的人。诊断为物质使用障碍的医疗患者，特别是那些与药物使用相关的诊断，比没有诊断为物质使用障碍的患者有更高的复发急性护理医院使用率。
Hospital discharge may be an opportunity to intervene among patients with substance use disorders to reduce subsequent hospital utilization. This study determined whether having a substance use disorder diagnosis was associated with subsequent acute care hospital utilization. We conducted an observational cohort study among 738 patients on a general medical service at an urban, academic, safety-net hospital. The main outcomes were rate and risk of acute care hospital utilization (emergency department visit or hospitalization) within 30 days of discharge. The main independent variable was presence of a substance use disorder primary or secondary discharge diagnosis code at the index hospitalization. At discharge, 17% of subjects had a substance use disorder diagnosis. These patients had higher rates of recurrent acute care hospital utilization than patients without substance use disorder diagnoses (0.63 vs 0.32 events per subject at 30 days, P < 0.01) and increased risk of any recurrent acute care hospital utilization (33% vs 22% at 30 days, P < 0.05). In adjusted Poisson regression models, the incident rate ratio at 30 days was 1.49 (95% confidence interval, 1.12–1.98) for patients with substance use disorder diagnoses compared with those without. In subgroup analyses, higher utilization was attributable to those with drug diagnoses or a combination of drug and alcohol diagnoses, but not to those with exclusively alcohol diagnoses. Medical patients with substance use disorder diagnoses, specifically those with drug use-related diagnoses, have higher rates of recurrent acute care hospital utilization than those without substance use disorder diagnoses.