Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm.
Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm.
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在老年人中，与7天的后续门诊精神保健相关的因素，因自杀念头，自杀未遂和自我伤害而住院。
DOI：
10.1016/j.jagp.2021.08.011
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发表时间：
2022-04
期刊：
影响因子：
--
通讯作者：
Marcus SC
中科院分区：
文献类型：
--
作者：
Schmutte T;Olfson M;Xie M;Marcus SC
老年人是寻求自杀意念和自我伤害紧急护理的增长最快的年龄段之一。及时跟进门诊精神卫生保健对预防自杀很重要，但对出院后护理连续性的预测因素知之甚少。这项研究确定了患者、医院和地区层面的因素，这些因素与有自杀倾向的老年人7天门诊精神卫生服务的随访有关。使用2015年医疗保险数据对因自杀念头、自杀未遂或故意自残(n=27,257)而住院的65岁成年人进行了回顾性队列分析，与美国医院协会调查和地区卫生资源文件相联系。根据患者、医院和区域变量对7天门诊精神卫生服务的随访率和调整后的风险比进行评估。总体而言，30.3%的患者在出院后7天内接受了后续心理健康护理。然而，入院前30天内接受过任何精神健康护理的患者的随访率(43.7%)高于最近没有接受精神健康护理的患者(15.7%)。住院和护理精神病院的时间越长，随访的几率就越高。对于在入院前30天内没有心理健康护理的患者，从大型、附属于系统的学术医疗中心出院，或提供以住院医生为基础的护理，与后续随访的几率较低相关。女性患者更有可能接受7天的随访，而非白人患者接受后续护理的可能性较小。及时的随访受到多个患者、医院和社区特征的影响。研究结果强调了质量改进的必要性，以促进从住院到门诊的成功过渡。
Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental health care is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental health care in suicidal older adults. Retrospective cohort analysis using 2015 Medicare data for adults aged ≥ 65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n=27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental health care. Overall, 30.3% of patients received follow-up mental health care within 7 days of discharge. However, follow-up rates were higher for patients with any mental health care within 30 days pre-hospitalization (43.7%) compared to patients with no recent mental health care (15.7%). Longer length of stay and care psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental health care in the 30 days pre-hospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-White patients were less likely to receive follow-up care. Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.
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