Mental illness and length of inpatient stay for medicaid recipients with AIDS.
Mental illness and length of inpatient stay for medicaid recipients with AIDS.
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患有艾滋病的医疗补助接受者的精神疾病和住院时间。
DOI：
10.1111/j.1475-6773.2004.00292.x
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发表时间：
2004
影响因子：
3.4
通讯作者：
Crystal,Stephen
中科院分区：
文献类型：
--
作者：
Hoover,DonaldR;Sambamoorthi,Usha;Walkup,JamesT;Crystal,Stephen
目标。研究医疗补助受益人艾滋病患者共病性精神疾病与住院时间（LOS）之间的关系。数据来源和收集/研究设置。合并1992 - 1998年从新泽西州获得的1992 - 1996年诊断为艾滋病后住院≥1次的成年人的医疗补助申请和艾滋病监测数据。研究设计。6247例艾滋病患者24975例住院患者的观察性研究。根据ICD-9代码确定就诊时的严重精神疾病（SMI）和其他较轻精神疾病（OMI）诊断。约4%的患者被诊断为重度精神分裂症；5%的人被诊断为OMI；43%的人没有精神疾病诊断，但被确定为有重度精神分裂症或重度精神分裂症病史的患者；48%的人来自没有精神病史的患者。主要的发现。总体平均住院时间为12.7天。在调整了多变量模型中HIV疾病严重程度和卫生保健可及性的测量后，诊断为原发性和继发性严重精神疾病（SMI）的患者的LOS分别比没有精神病史的类似患者长32%和11% （p<0.001）。但在这些调整后的住院时间模型中：(1)OMI的诊断与LOS无关；(2)在就诊时没有诊断出精神疾病的情况下，SMI或OMI的确诊史也与LOS无关。在调整后的再入院时间模型中，当前重度精神疾病或OMI的诊断，以及没有当前诊断的重度精神疾病或OMI的历史，都倾向于与更快的再入院有关。结论：本研究发现，在就诊时诊断为严重精神疾病的艾滋病患者（而不是那些诊断为较轻精神合并症的患者）具有更高的（调整后的）LOS。急性严重精神疾病对住院时间的影响可能与急性艾滋病机会性疾病相当。虽然先前的研究提出了精神疾病通过干扰艾滋病毒治疗而增加LOS的担忧，但这里的关联可能只是表明需要额外的时间来治疗严重的精神疾病或安排患者出院。
Objective.To examine the associations between comorbid mental illness and length of hospital stays (LOS) among Medicaid beneficiaries with AIDS.Data Source and Collection/Study Setting.Merged 1992–1998 Medicaid claims and AIDS surveillance data obtained from the State of New Jersey for adults with ≥1 inpatient stay after an AIDS diagnosis from 1992 to 1996.Study Design.Observational study of 6,247 AIDS patients with 24,975 inpatient visits. Severe mental illness (SMI) and other less severe mental illness (OMI) diagnoses at visits were ascertained from ICD–9 Codes. About 4 percent of visits had an SMI diagnosis; 5 percent had an OMI diagnosis; 43 percent did not have a mental illness diagnosis, but were patients who had been identified as having an SMI or OMI history; and 48 percent were from patients with no identified history of mental illness.Principal Findings.The overall mean hospital LOS was 12.7 days. After adjusting for measures of HIV disease severity and health care access in multivariate models, patients presenting with primary and secondary severe mental illness (SMI) diagnoses had ∼32 percent and ∼11 percent longer LOS, respectively, than did similar patients without a mental illness history (p<0.001 for each). But in these adjusted models of length of stay: (1) diagnosis of OMI was not related to LOS, and (2) in the absence of a mental illness diagnosed at the visit, an identified history of either SMI or OMI was also not related to LOS. In adjusted models of time to readmission for a new visit, current diagnosis of SMI or OMI and in the absences of a current diagnosis, history of SMI or OMI all tended to be associated with quicker readmission.Conclusions.This study finds greater (adjusted) LOS for AIDS patients diagnosed with severe mental illness (but not for those diagnosed with less severe mental comorbidity) at a visit. The effect of acute severe mental illness on hospitalization time may be comparable to that of an acute AIDS opportunistic illness. While previous research raises concerns that mental illness increases LOS by interfering with treatment of HIV conditions, the associations here may simply indicate that extra time is needed to treat severe mental illnesses or arrange for discharge of afflicted patients.
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