Unforeseen inpatient mortality among veterans with schizophrenia
Unforeseen inpatient mortality among veterans with schizophrenia
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DOI：
10.1097/01.mlr.0000196973.99080.fb
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发表时间：
2006-02-01
期刊：
影响因子：
3
通讯作者：
Miller, AL
中科院分区：
文献类型：
--
作者：
Copeland, LA;Zeber, JE;Miller, AL
背景：精神分裂症患者和其他患者一样，有共同的医疗条件，但可能缺乏提供良好自我护理或与提供者合作确保适当医疗的能力。方法：对02财年在退伍军人事务部(VA)医院死亡的所有患者按死亡类型进行分类：意外死亡(年龄80岁，前一年住院1-2天)、癌症、器官衰竭(心、肺、肾)、虚弱(痴呆、髋部骨折、脱水等)或其他死亡。Logistic回归分析意外死亡的因素。结果：在这一年中，27798名患者死于退伍军人医院；3%的患者患有精神分裂症(n=943)。大约三分之二的死亡是由于癌症或器官衰竭，11%的人虚弱，9%的人其他，8%的人符合不可预见的死亡标准。然而，在精神分裂症患者中，20%属于意外死亡类别。在调整后的模型中，与任何其他类别相比，精神分裂症与意外死亡的风险增加2倍(优势比=2.4，95%可信区间1.6-3.4)。在死亡前一年有药物滥用诊断的患者中，意外死亡的可能性较小，而在没有门诊医疗的情况下，意外死亡的可能性更大。结论：与其他没有精神分裂症的住院患者相比，退伍军人精神分裂症患者在住院期间死亡的可能性更大。外展工作可能是必要的，以使精神分裂症患者参与到潜在危及生命的疾病的治疗中。
Background: Patients with schizophrenia have co-occurring medical conditions, like other patients, but may lack the capacity to provide good self-care or to work with their providers to ensure appropriate medical treatment. We hypothesized that death among patients with schizophrenia occurs more frequently after minimal care of comorbid conditions.Methods: All patients who died in veterans affairs (VA) hospitals during FY02 were categorized as to type of death: unforeseen (age < 80 years, 1-2 inpatient days past year), cancer, organ failure (heart, lungs, kidneys), frailty (dementias, hip fractures, dehydration, etc.), or other deaths. Logistic regression explored factors in unforeseen death.Results: During the year, 27,798 patients died in VA facilities; 3% had schizophrenia (n = 943). Roughly two-thirds of all deaths were from cancer or organ failure, 11% frailty, 9% other, and 8% met criteria for unforeseen death. Among patients with schizophrenia however, 20% fell into the unforeseen death category. In an adjusted model, schizophrenia was associated with a 2-fold increased risk of unforeseen death compared with any other category (odds ratio = 2.4, 95% confidence interval 1.6-3.4). Unforeseen death was less likely among patients with substance abuse diagnoses in the year before death and more likely when patients had no outpatient medical care.Conclusions: VA patients with schizophrenia were more likely to die as inpatients with little previous-year care compared with other inpatient decedents without schizophrenia. Outreach efforts may be necessary to engage patients with schizophrenia in treatment of potentially life-threatening conditions.