Variation in patterns of health care before suicide: A population case-control study
Variation in patterns of health care before suicide: A population case-control study
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DOI：
10.1016/j.ypmed.2019.105796
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发表时间：
2019-10-01
影响因子：
5.1
通讯作者：
Simon, Gregory E.
中科院分区：
文献类型：
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作者：
Ahmedani, Brian K.;Westphal, Joslyn;Simon, Gregory E.
背景：美国自杀率大幅上升。随着决策者确定如何解决这一全国性问题，医疗保健系统已被确定为预防的最佳场所。目的：比较自杀死亡的个人和普通人群之间的医疗保健使用模式的变化。设计：病例对照研究。设置：美国的八个医疗保健系统。参与者：2000年至2013年沿着期间死于自杀的2674人以及在健康计划成员资格和健康系统附属关系的时间段上匹配的267，400人。急诊室、住院医院、初级保健中的医疗保健用途，和门诊专科设置测量使用电子健康记录数据在自杀前7天，30天，60天，90天，180天，和365天的时间段和匹配的索引日期为对照。对于自杀死亡的人来说，医疗保健使用在所有医疗保健环境中更为常见。近30%的人在自杀前7天内进行了医疗保健访问（6.5%急诊，16.3%门诊专科和9.5%初级保健），超过一半在30天内，超过90%在365天内。在这一年中，死于自杀的人平均有16.7次医疗保健访问。自杀的相对风险是最大的个人谁接受护理的住院设置（aOR = 6.23）。自杀前在急诊室的相对危险度（aOR = 3.08）和绝对利用率（43.8%）都很高。样本不包括未投保的individuals.Conclusions：这项研究提供了重要的数据，如何照顾利用不同的自杀死亡的人相比，一般人群，可以告知决策者针对自杀预防活动在卫生系统内。
Background: The United States has experienced a significant rise in suicide. As decision makers identify how to address this national concern, healthcare systems have been identified as an optimal location for prevention.Objective: To compare variation in patterns of healthcare use, by health setting, between individuals who died by suicide and the general population.Design: Case-Control Study.Setting: Eight healthcare systems across the United States.Participants: 2674 individuals who died by suicide between 2000 and 2013 along with 267,400 individuals matched on time-period of health plan membership and health system affiliation.Measurements: Healthcare use in the emergency room, inpatient hospital, primary care, and outpatient specialty setting measured using electronic health record data during the 7-, 30-, 60-, 90-, 180-, and 365-day time periods before suicide and matched index date for controls.Results: Healthcare use was more common across all healthcare settings for individuals who died by suicide. Nearly 30% of individuals had a healthcare visit in the 7-days before suicide (6.5% emergency, 16.3% outpatient specialty, and 9.5% primary care), over half within 30 days, and > 90% within 365 days. Those who died by suicide averaged 16.7 healthcare visits during the year. The relative risk of suicide was greatest for individuals who received care in the inpatient setting (aOR = 6.23). There was both a large relative risk (aOR = 3.08) and absolute utilization rate (43.8%) in the emergency room before suicide.Limitations: Participant race/ethnicity was not available. The sample did not include uninsured individuals.Conclusions: This study provides important data about how care utilization differs for those who die by suicide compared to the general population and can inform decision makers on targeting of suicide prevention activities within health systems.