Predictors of psychiatric readmissions in the short- and long-term: a population-based study in Taiwan.
Predictors of psychiatric readmissions in the short- and long-term: a population-based study in Taiwan.
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DOI：
10.1590/s1807-59322010000500005
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发表时间：
2010-05
期刊：
影响因子：
--
通讯作者：
Li CY
中科院分区：
文献类型：
--
作者：
Lin CH;Chen WL;Lin CM;Lee MD;Ko MC;Li CY
目的探讨台湾精神科人群出院后14天、1年及5年再入院风险、再入院率及其预测因子。这是一项前瞻性研究，基于2000年出院的44,237名首次住院的精神病患者的索赔，这些患者出院后随访长达5年。计算出院后各随访期的再入院累积发生率和再入院发生率密度，并建立Cox比例风险模型，以确定精神科再入院的重要预测因素。小于14天、1年和5年的累计发病率分别为6.1%、22.3%和37.8%。发病率密度分别为4.58、1.04和0.69 /千人日。与随访时间长短无关的某些因素与再入院风险增加显著相关，包括男性性别、住院时间超过15天、经济贫困、主要的精神分裂症/情感性障碍出院诊断以及居住在城市化程度较低的地区。与儿童/青少年相比，年轻人（20-39岁）与<1年和< 5年再入院的风险增加显著相关，但与<14天再入院的风险无关。此外，医院特征与<14天和<1年再入院风险增加显著相关，但与< 5年再入院风险无关。本研究发现，出院后14天至5年精神病学再入院的显著预测因子除患者年龄和医院认可水平外基本相同。本研究还强调了社会经济因素在预测再入院中的重要性。
To explore the risks and rates of readmission and their predictors 14 days, one year, and five years after discharge for the psychiatric population in Taiwan. This was a prospective study based on claims from 44,237 first-time hospitalized psychiatric patients discharged in 2000, who were followed for up to five years after discharge. The cumulative incidence and incidence density of readmission were calculated for various follow-up periods after discharge, and Cox proportional hazard models were generated to identify the significant predictors for psychiatric readmission. The less than 14-day, one-year, and five-year cumulative incidences were estimated at 6.1%, 22.3%, and 37.8%, respectively. The corresponding figures for incidence density were 4.58, 1.04, and 0.69 per 1,000 person-days, respectively. Certain factors were significantly associated with increased risk of readmission irrespective of the length of follow-up, including male gender, length of hospital stay >15 days, economic poverty, a leading discharge diagnosis of schizophrenia/affective disorders, and residence in less-urbanized regions. Compared to children/adolescents, young adults (20–39 years) were significantly associated with increased risks of <one-year and <five-year readmissions, but not <14-day readmission. Additionally, hospital characteristics were significantly associated with increased risk of <14-day and <one-year readmission, but not with risk of <five-year readmission. This study found that the significant predictors for psychiatric readmission 14 days to five years after discharge were essentially the same except for patient’s age and hospital accreditation level. This study also highlighted the importance of socioeconomic factors in the prediction of readmission.