Aftercare, Emergency Department Visits, and Readmission in Adolescents
Aftercare, Emergency Department Visits, and Readmission in Adolescents
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DOI：
10.1016/j.jaac.2011.12.003
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发表时间：
2012-03-01
影响因子：
13.3
通讯作者：
To, Teresa
中科院分区：
文献类型：
--
作者：
Carlisle, Corine E.;Mamdani, Muhammad;To, Teresa
目的：美国和加拿大的数据显示，住院天数减少，非紧急急诊（艾德）就诊增加，儿童精神科医生供应短缺。我们的研究旨在确定是否善后减少艾德访问和/或再入院的青少年首次精神病住院。方法：我们进行了一项基于人群的队列分析，使用了2002年4月1日至2004年3月1日的关联卫生管理数据库。该研究队列包括所有15至19岁的青少年首次精神病入院。在出院后的一个月内，有和没有善后照顾的青少年在接受善后照顾的倾向上进行了匹配。我们的主要结果是首次精神科艾德就诊或再入院的时间。次要结局分别为至首次精神艾德访视和再入院的时间。结果：我们确定了4，472名首次精神病住院的青少年。其中，57%在出院后一个月内接受了善后辅导。基于倾向分数的匹配，占每个人的倾向善后，产生了一个队列的3,004名青少年。在配对分析中，相对于那些在出院后一个月内没有接受后续护理的患者，接受后续护理的患者合并结局的可能性增加（风险比[HR] = 1.22，95%置信区间[CI] = 1.05-1.42）和再入院（I-IR = 1.38，95% CI = 1.14-1.66），但不包括艾德访视（HR = 1.14，95% CI = 0.95-1.37）。结论：我们的研究结果具有挑衅性：我们发现出院后一个月的善后护理增加了再入院的可能性，但没有增加艾德就诊的可能性。除了严重程度和加拿大/美国系统差异的混淆之外，我们的研究结果可能表明青少年相对缺乏精神病服务。我们的研究结果表明，需要改进儿科心理健康服务使用的数据采集。J. Am. Acad.儿童青少年精神病学，2012;51（3）：283-293.
Objective: U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. Method: We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately. Results: We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-score based matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.05-1.42), and readmission (I-IR = 1.38, 95% CI = 1.14-1.66), but not ED visits (HR = 1.14, 95% CI = 0.95-1.37). Conclusions: Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use. J. Am. Acad. Child Adolesc. Psychiatry, 2012;51(3):283-293.