Diagnosis of unipolar depression following initial identification of bipolar disorder: a common and costly misdiagnosis.
Diagnosis of unipolar depression following initial identification of bipolar disorder: a common and costly misdiagnosis.
复制标题
初步鉴定双相情感障碍后诊断单相抑郁症：一种常见且代价高昂的误诊。
DOI：
10.4088/jcp.v69n0508
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
J. Frytak
中科院分区：
文献类型：
--
作者：
M. Stensland;J. Schultz;J. Frytak
背景
双相情感障碍在医疗实践中诊断具有挑战性。
目标
我们的目的是（1）确定行政索赔中先前诊断为双相情感障碍的患者中抑郁症误诊的比率，（2）确定由此增加的治疗费用，（3）验证一部分患者的病历中的误诊。
方法
我们采用队列分析，使用2001年1月至2003年12月美国大型商业健康计划的索赔。入选标准包括2个双相情感障碍诊断（ICD-9-CM标准），在首次双相情感障碍诊断前后连续入组1年，年龄18-64岁，以及药房获益。倾向评分用于控制双相情感障碍诊断后一年内有和无2种抑郁症诊断的患者之间的差异。获得了100名患者的病历，其中76名患者的双相情感障碍诊断表来自一名提供者，抑郁症诊断表来自第二名提供者。
结果
在符合入选标准的3119例双相情感障碍患者中，857例（27.5%）在随访期间发生了随后的抑郁症误诊。这些患者的精神病住院次数是其他患者的1.82倍，精神病急诊室就诊次数是其他患者的2.47倍。对于673例患者（78.5%），不同的提供者给了抑郁症误诊。被诊断患有抑郁症的患者的年人均治疗费用（12,594美元）显著高于非抑郁症患者（9405美元）（p <0.001）。在病历审查中，65.8%（50/76）的患者（病历来自2个不同的提供者）确认了双相情感障碍和随后的抑郁症诊断。
结论
超过四分之一的被诊断为双相情感障碍的人在随访期间接受了表面上的抑郁症误诊。精神科住院患者的显著增加（p = 0.001）表明，改善护理的连续性可以改善结果并降低成本。
BACKGROUND
Bipolar disorder is challenging to diagnose in medical practice.
OBJECTIVES
Our objectives were (1) to determine the rate of depression misdiagnosis in patients previously diagnosed with bipolar disorder in administrative claims, (2) to determine the resulting increased treatment costs, and (3) to verify the misdiagnoses in the medical charts for a subset of patients.
METHOD
We employed cohort analysis using claims from a large, commercial, U.S. health plan from January 2001 through December 2003. Inclusion criteria included 2 bipolar disorder diagnoses (ICD-9-CM criteria), continuous enrollment for 1 year before and after initial bipolar disorder diagnosis, age 18-64 years, and a pharmacy benefit. Propensity scoring was used to control for differences between patients with and without 2 depression diagnoses in the year following their bipolar disorder diagnosis. Medical charts were obtained for 100 patients, including 76 with a bipolar disorder diagnosis chart from one provider and a depression diagnosis chart from a second provider.
RESULTS
Of 3119 bipolar disorder patients meeting inclusion criteria, 857 (27.5%) had subsequent depression misdiagnoses during the follow-up year. These patients had 1.82 times more psychiatric hospitalizations and 2.47 times more psychiatric emergency room visits. For 673 patients (78.5%), a different provider gave the depression misdiagnosis. Annual per-patient treatment costs were significantly higher (p < .001) for those diagnosed with depression ($12,594) than for those not ($9405). In the chart review, both the bipolar disorder and subsequent depression diagnoses were confirmed for 65.8% (50/76) of the patients who had charts from 2 different providers.
CONCLUSIONS
More than one quarter of individuals diagnosed with bipolar disorder received an ostensible depression misdiagnosis during the follow-up period. Significant (p = .001) increases in psychiatric inpatient hospitalization suggest that improvements in the continuity of care could improve outcomes and reduce costs.