Effective mental health interventions to reduce hospital readmission rates: a systematic review.
Effective mental health interventions to reduce hospital readmission rates: a systematic review.
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DOI：
10.21037/jhmhp.2018.08.05
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发表时间：
2018-09-01
期刊：
影响因子：
--
通讯作者：
Chen, Jie
中科院分区：
文献类型：
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作者：
Benjenk, Ivy;Chen, Jie
背景：在美国，因心力衰竭、急性心肌梗死（AMI）、肺炎、慢性阻塞性肺疾病（COPD）、冠状动脉搭桥（CABG）手术或髋关节和膝关节置换术而住院的患者，如果30天再入院率高于预期，医院将受到经济处罚。因这些疾病住院的患者，如果有精神健康诊断或症状合并症，再入院的风险很高。方法：我们进行了一项系统综述，以确定专门用于评估或治疗精神健康症状的干预措施是否能有效降低因身体健康状况住院后再入院的风险。我们在PubMed和谷歌Scholar上搜索了2010年1月至2018年6月期间发表的同行评议文章，这些文章研究了心理健康干预对身体状况再入院的影响。结果：在筛选了81篇全文文章后，我们发现11项干预研究、1项荟萃分析和1项横断面研究符合我们的纳入标准。只有三项干预研究发现干预组和对照组在再入院率上存在显著差异。这些干预措施中的每一项都针对出院后的患者。其中一项干预措施是对最初因心力衰竭入院的患者进行身体健康远程监测和个人心理治疗干预。第二次干预是对最初因急性心肌梗死入院的患者进行个人和团体心理治疗。第三项干预是针对最初因任何身体健康状况而入院的有抑郁症状的家庭护理患者实施护士驱动的抑郁护理管理方案。横断面研究表明，拥有更强大的、以社会为基础的公共精神卫生基础设施的社区，其身体健康再入院率显著降低。结论：本综述中发现的文献似乎支持出院后使用心理健康干预作为减少身体健康状况再入院的机制。未来的研究需要确定这些干预措施是否能具体减少与经济处罚相关的六种情况的30天再入院率。
BACKGROUND: Hospitals in the United States are financially penalized for having a higher than expected thirty-day readmission ratio among patients initially hospitalized for heart failure, acute myocardial infarction (AMI), pneumonia, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG) surgery, or hip and knee replacement. Patients hospitalized for these conditions that have comorbid mental health diagnoses or symptoms are at high risk for readmission.METHODS: We conducted a systematic review to determine if interventions, that are specifically designed to assess or treat mental health symptoms, can effectively reduce risk of readmission following hospitalization for physical health conditions. We searched on PubMed and Google Scholar for peer-reviewed articles published between January 2010 and June 2018 that examined the impact of mental-health interventions on readmissions for physical conditions.RESULTS: After screening 81 full text articles, we found eleven intervention studies, one meta-analysis, and one cross-sectional study that met our inclusion criteria. Only three of the intervention studies found significant differences in readmission rates between intervention and comparison groups. Each of these interventions targeted patients after discharge from the hospital. One of the interventions was a physical health telemonitoring and individual psychotherapy intervention for patients that were initially admitted for heart failure. The second intervention was individual and group psychotherapy sessions for patients who were initially admitted for AMI. The third intervention was a nurse-driven depression care management protocol for home care patients with depressive symptoms who were initially admitted for any physical health condition. The cross-sectional study showed that communities with a stronger, social-based public mental health infrastructure had significantly lower physical health readmission rates.CONCLUSIONS: The literature identified in this review, appears to provide support for the use of mental health interventions after discharge as a mechanism for reducing physical health condition readmissions. Future research is needed to determine if these interventions can specifically reduce thirty-day readmissions for the six conditions linked to financial penalties.