Predictors of Admission in First-Episode Psychosis: Developing a Risk Adjustment Model for Service Comparisons
Predictors of Admission in First-Episode Psychosis: Developing a Risk Adjustment Model for Service Comparisons
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DOI：
10.1176/appi.ps.61.5.483
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发表时间：
2010-05-01
影响因子：
3.8
通讯作者：
McKenzie, Emily
中科院分区：
文献类型：
--
作者：
Addington, Donald Emile;Beck, Cindy;McKenzie, Emily
目的：本研究的目的是开发一个基于入院情况的风险调整模型，以便能够比较为首发精神病患者提供的服务。方法：在文献综述中确定住院入院的候选预测变量，一个专家小组通过一个结构化的过程，即风险调整信息传递的模板，从其中选择12个潜在的风险调整变量。使用12个变量的多变量Logistic回归模型在一个首发精神病患者队列(N=297)中建立模型；这些模型用来自第二个队列(N=309)的数据验证。C统计量是衡量模型辨别力的指标，用来评估模型的性能。结果：在来自发展样本的数据中，既往住院是参加首发精神病项目后一年内住院人数的唯一显著预测因素(优势比[OR]=1.88，p=0.05)。入院两年和三年后住院与较高水平的初始阳性症状显著相关(OR=1.07，p=0.02；OR=1.06，p=0.02)，以及既往住院(OR=2.72，p=.001；OR=3.34，p
Objective: The aim of this study was to develop a risk adjustment model based on hospital admissions that would enable comparison between services for patients with a first episode of psychosis. Methods: Candidate predictor variables for hospital admission were identified in a literature review, from which an expert panel selected 12 potential risk adjustment variables by using a structured process, the Template for Risk Adjustment Information Transfer. Multivariable logistic regression modeling with the 12 variables was used to develop models in one cohort of first-episode psychosis patients (N=297); these models were validated with data from a second cohort (N=309). The C statistic, a measure of model discrimination, was calculated to assess model performance. Results: In the data from the development sample, prior hospitalization was the only significant predictor of hospital admissions within one year of enrollment in the first-episode psychosis program (odds ratio [OR]=1.88, p=.05). Hospital admissions after two and three years from admission to the program were significantly associated with higher levels of initial positive symptoms (OR=1.07, p=.02; OR=1.06, p=.02, respectively), and prior hospitalizations (OR=2.72, p=.001; OR=3.34, p