Length of stay, referral to aftercare, and rehospitalization among psychiatric inpatients
Length of stay, referral to aftercare, and rehospitalization among psychiatric inpatients
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DOI：
10.1176/appi.ps.54.9.1271
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发表时间：
2003-09-01
影响因子：
3.8
通讯作者：
Trierweiler, S
中科院分区：
文献类型：
--
作者：
Hompson, EE;Neighbors, HW;Trierweiler, S
目的：通过对1991年11月至1994年7月在某公立精神病院住院的1,481例住院患者的资料进行分析，探讨住院患者出院后6个月内再住院、住院时间与后续护理之间的相互关系。Logistic回归模型被用来预测在指数出院后6个月内转诊至后续护理和再次入院的可能性。受控变量为患者的特征；出院时的精神状态，包括住院时间；以及非正式支持的可用性。结果：16%的患者接受了后续护理的转介，约13%的患者在出院后6个月内再次入院。白人患者得到转诊到后续护理的可能性是非裔美国人的两倍。住院时间和精神分裂症的诊断也是转诊到后续护理的预测因素。转诊至善后护理并不能调节住院时间和再住院之间的关系。然而，有分裂情感障碍，出院预后差，以及以前入院次数多与再次入院的风险增加相关。没有其他人口统计学特征与出院后6个月内的再入院有关，但转诊到善后护理显著增加了再入院的风险。结论：这项研究表明转诊到善后护理过程中可能存在种族差异，转诊和再住院之间存在复杂的关系。这两个发现都值得进一步调查，特别注意个人一级的需求指标和系统一级的障碍和精神护理的促进者。
Objective: This retrospective study explored the interrelationship among aftercare, length of hospital stay, and rehospitalization within six months of discharge in a sample of psychiatric inpatients.Methods: Data were analyzed for 1,481 patients who had received inpatient care at a state psychiatric hospital from November 1991 to July 1994. Logistic regression models were estimated to predict the likelihood of referral to aftercare and of readmission to a hospital within six months of the index discharge. Variables controlled for were patients' characteristics; psychiatric status at the time of discharge, including length of stay; and the availability of informal support.Results: Sixteen percent of the patients received a referral to aftercare, and about 13 percent of the patients were readmitted within six months of discharge. White patients were twice as likely as African Americans to receive a referral to aftercare. Length of hospitalization and having a diagnosis of schizophrenia were also predictors of referral to aftercare. Referral to aftercare was not shown to mediate the relationship between length of stay and rehospitalization. However, having a schizoaffective disorder, a poor discharge prognosis, and a high number of previous admissions were associated with an increased risk of readmission. No other demographic characteristics were related to readmission within six months of discharge, but referral to aftercare significantly increased the risk of readmission.Conclusions: The study suggested the possibility of racial disparities in referral to aftercare and a complex relationship between referral and rehospitalization. Both these findings warrant further investigation that gives particular attention to individual-level indicators of need and system-level barriers to and facilitators of psychiatric care.