2008年-2018年广西省某精神专科医院入院人次季节变化及趋势预测

目的 分析广西省某精神专科医院精神障碍患者入院人次的季节性变化,预测2019年-2021年入院人次,为优化医院管理和资源配置提供参考。 方法 统计广西省某三级精神专科医院2008年-2018年各月份的入院人次,利用季节指数法对11年间各月（季度）进行动态分析,并用灰色模型预测2019年-2021年入院人次。 结果 该院2月、3月、4月、5月、10月、12月精神障碍患者入院人次季节指数均大于100%,分别为100.53%、115.86%、106.76%、102.58%、100.93%、100.43%。通过灰色预测模型建模,预测2019年-2021年入院量分别为6 878、7 476、8 125人次。 结论 2012年-2021年该医院精神障碍患者年入院人次呈逐年递增趋势,上半年尤其是春季为入院高峰期。     

《精神卫生法》颁布后精神专科医院患者入院方式的现状调查

目的 了解《中华人民共和国精神卫生法》颁布后精神专科医院患者的入院方式.方法 随机抽取重庆市精神卫生中心2013年5月1日~2016年4月30日收治住院的精神障碍患者住院病历313份,采用自制调查量表对入院方式等进行横断面调查.结果 313例患者中自愿入院者128例(40.9%),非自愿入院185例(59.1%).两组患者临床诊断分布、自知力、治疗意愿的差异有统计学意义(P<0.01);非自愿入院患者中严重精神障碍患者比例更高(P<0.01).Logistic回归显示治疗意愿是非自愿住院的危险因素(OR=3.231,95%CI=1.657~6.300,P<0.01).结论 精神卫生法颁布实施以来,精神专科医院精神障碍患者入院方式仍以非自愿住院为主,受患者治疗意愿影响.     

基于病历会商制度的动脉瘤性蛛网膜下腔出血医疗效率改进模式——一种持续高效的脑血管病医师继续教育方式

目的 探讨基于病历会商制度的动脉瘤性蛛网膜下腔出血（aneurysmal s ubarachnoid h emorrhages， aSAH）医疗服务效率改进模式对脑血管病医师的继续教育作用及其成效分析。 方法 首都医科大学附属北京天坛医院自2013年7月开始对脑血管病医师进行基于病历会商制度的 aSAH治疗效率持续改进模式教育，评价2013年1月-6月与2017年7月-12月两个时间段脑血管病医师对 aSAH患者发病72 h内介入栓塞或外科夹闭术治疗率变化及患者到院距接受治疗平均时间的差异。 结果 通过基于病历会商制度的aSAH医疗服务效率改进模式的继续教育制度，脑血管病医师对 aSAH患者的治疗效率有显著改善[患者发病72h治疗率：83.6% vs 55.3%，P＜0.001；患者到院距接受 治疗的平均时间：（45.0±31.3）h vs（78.6±51.8）h，P＜0.001]。 结论 基于病历会商制度的aSAH医疗服务效率改进模式是一种持续高效的脑血管病医师继续教育 方式。     

复发性抑郁障碍发病与季节气象要素变化的关联分析

目的了解抑郁障碍的复发与季节气象要素变化的相关性,为复发性抑郁障碍的防治提供参考。方法收集2013年-2017年深圳市某精神病专科医院复发性抑郁障碍住院患者病历资料和同期气象资料,对复发性抑郁障碍月入院量与同期各气象要素进行相关分析,采用多元线性回归模型进一步分析季节气象因素对抑郁障碍复发的影响。结果复发性抑郁障碍月入院量最多的三个月份分别为5月[85例(10. 39%)]、7月[78例(9. 54%)]和8月[77例(9. 41%)];入院量最多的季节为秋季[226例(27. 6%)],其次为夏季[212例(25. 9%)]。不同性别的复发性抑郁障碍月入院量差异无统计学意义(χ~2=9. 947,P0. 05)。复发性抑郁障碍患者月入院量与月平均降水量、月平均相对湿度呈正相关(r=0. 292、0. 370,P0. 05),与月平均风速呈负相关(r=-0. 475,P0. 05)。多元线性回归分析表明,月均风速越慢、月均湿度越高,复发性抑郁障碍入院量越高(P0. 05)。结论复发性抑郁障碍发病具有季节性,气象要素变化与复发性抑郁障碍发病存在关联,尤其是湿度与风速变化。     

ICD-11精神与行为障碍（草案）关于心境障碍诊断标准的进展北大核心CSCD

心境障碍（mood disorders）是一类具有高患病率、高复发率、高自杀率和高致残性等特点的情绪障碍,也是一个严重的公共卫生问题.根据2017年国家卫生计生委疾病预防控制局公布的、由北京大学第六医院黄悦勤教授负责的＂中国精神障碍疾病负担和服务利用研究＂项目的主要调查结果显示,我国心境障碍患病率为4.06%.据2010年全球疾病负担调查结果显示,心境障碍是首要的慢性疾病负担,同时也是自杀和缺血性心脏病的主要影响因素,严重影响患者的心身健康,对其家庭和社会带来巨大的精神压力及经济负担.     

一户多名严重精神障碍家庭监护人现状及患者服药依从性影响因素调查

目的调查一户多名严重精神障碍患者家庭监护人现状和患者服药依从性的影响因素,为有针对性地对此群体给予精神卫生服务提供参考。方法于2017年11月-2018年5月从国家严重精神障碍管理治疗系统中选取重庆市江北区、沙坪坝区、万州区一户多名严重精神障碍患者家庭110户,采用自制调查表收集患者及其监护人一般人口学资料及患者临床资料、服药情况等。结果①在110户严重精神障碍患者家庭中,无监护人家庭为10户(9. 1%),有1名监护人的家庭为84户(76. 4%),有2名监护人的家庭为16户(14. 5%);②有3名患者的家庭共4户(3. 6%),有2名患者的家庭共106户(96. 4%);③患者服药依从性与其居住地(r=0. 201,P0. 01)、是否与监护人同住(r=0. 193,P0. 01)及受教育程度(r=0. 370,P0. 01)呈正相关,两名患者服药依从性之间呈正相关(r=0. 451,P0. 01);④有序Logistic回归分析显示,是否与监护人同住(OR=-1. 14)、小学及以下(OR=20. 24)、初中受教育程度(OR=18. 94)对患者服药依从性产生影响。结论一户多名严重精神障碍患者之间服药依从性呈正相关,与监护人同住是患者服药依从性的保护因素,患者受教育程度低是服药依从性的危险因素。     

2013年荆门市重性精神疾病患者流行病学现状分析

目的 了解荆门市重性精神疾病患者的流行病学分布、生活状态、就医情况及影响因素,为开展公共卫生服务、社区防治工作提供依据.方法 以ICD-10和CCMD-3为诊断标准,向各乡镇卫生院、社区卫生服务中心下发统一的线索调查表,由精神科专业医生对可疑患者进行复核确诊,对2010~2013年纳入国家管理系统的重性精神疾病患者信息进行核对和整理,导出信息并与调查数据进行比较分析.结果 2010~2013年全市共管理重性精神疾病患者9612例,检出率为3.34‰;以精神分裂症(76.77%)为主,检出率为1.99‰;男女比例为1:1.125;患者以18~44岁的青壮年(54.23%)为主;婚姻状况以已婚(55.33%)为主;经济状况以贫困(63.31%)为主;文化程度以文盲(24.15%),小学(31.42%),初中(34.16%)为主;职业以农民(76.51%)及无业(20.89%)为主;病程多在10年以上;精神发育迟滞伴发精神障碍患者住院及治疗比例最低(28.78%);躯体疾病及并发症(66.15%)和意外事故(28.46%)为患者的主要死亡因素.结论 精神分裂症、精神发育迟滞伴精神障碍、双相(情感)障碍患者居荆门市重性精神疾病前3位,女性多于男性,年龄集中在18~45岁,已婚比例低,离婚及丧偶比例高,文化程度低,患者经济负担重,病情迁延,治疗负担重,建议加强和完善各级防治网络建设及社区精神卫生服务,加强重性精神疾病患者的管理,加大政府及公益资金投入.     

缺血性卒中医疗质量持续改进项目实施效果分析

目的 评价缺血性卒中医疗质量持续改进项目（continued quality improvement,CQI）前后缺血性卒中医 疗质量的变化。 方法 收集山西省心血管医院神经内科进行缺血性卒中医疗质量持续改进前（2013年10月-2014年3 月）住院治疗的缺血性卒中患者261例作为基线组,实施质量改进方案后（2014年4月-2014年11月）收 治的缺血性卒中患者218例作为干预组,比较两组12项医疗质量关键绩效指标（key performance index, KPI）以及综合医疗质量指标的变化。 结果 实施医疗质量持续改进后干预组综合医疗质量指标为92.53%,高于基线组（81.52%) (P <0.001）。干预组各项KPI指标较基线组均有不同程度的提高,其中吞咽困难筛查（99.54% vs 96.55%,P =0.03）、康复干预（88.07% vs 68.22%,P <0.001）、他汀药物使用（98.62% vs 77.01%, P <0.001）、心房颤动患者抗凝治疗（66.67% vs 20.00%,P =0.02）执行率有明显的升高。 结论 实施标准缺血性卒中医疗质量持续改进方案有助于改善卒中医疗服务质量,值得进一步推广 应用。     

优质护理服务在精神科男性病房应用中的效果研究

目的探讨优质护理服务在精神科男性病房临床应用中的效果。方法在芜湖市第四人民医院两个男性病房中抽取2012年10月-2013年4月入院的急性精神障碍住院患者60例,采用随机数字表法分为优质护理组和对照组各30例,采用护士用住院患者观察量表(NOSIE)及医院住院患者满意度调查表进行测评。结果两组住院第2周末NOSIE社会兴趣因子分、个人整洁因子分、迟缓因子分、总消极评分、总评分比较,差异有统计学意义(P0.05或0.01),出院前1周优质护理组社会兴趣因子评分高于对照组(P0.001)。优质护理组与对照组的综合满意度分别为100%、96.34%。结论优质护理服务可能会对住院精神病患者的治疗和康复起到积极作用。     

社区在册精神分裂症患者治疗率及影响因素研究

目的通过了解精神分裂症的治疗现状及影响因素为干预措施提供依据.方法采用<精神分裂症治疗情况调查表>,内容包括一般项目、病情、对社会影响、治疗情况、医疗费用来源、家庭结构、经济收入、未治原因等.对1829例登记在册精神分裂症治疗现状进行调查.资料采用Excel进行统计.结果实访病例1782人,实访率97.43%.精神分裂症时点治疗率50.34%,从未治疗率5.78%.影响治疗率的因素为性别、婚姻、教育、职业、医疗费用来源及城乡差别.男性治疗率高于女性(P＜0.005),未婚及离异病人高于在婚及丧偶者(P＜0.001),高中组高于文盲组(P＜0.001),工人高于农民(P＜0.001),医保病人高于农村合作医疗病人(P＜0.001),城镇高于农村(P＜0.001).未治原因中首要因素为觉得病已好的占76.61%,其次为否认有病占11.64%,对治疗无信心占6.33%和经济困难者占4.18%.结论提高治疗率应开展精神卫生知识的宣传和教育,扩大综合性医院的心理咨询服务和早期预防监测.政府应增加对精神卫生事业的投入,建立农村基本医疗保险制度,对低收入精神分裂症患者加大大病救助和门诊费用的补助力度.     

成都市精神卫生服务资源五年发展分析

目的 对比分析2012年及2017年成都市精神卫生资源,了解成都市精神卫生医疗机构建设发展的现状和问题,为制定下一步精神卫生体系、人力和服务发展规划提供参考。 方法 于2018年1月-3月,采用成都市精神卫生资源调查表对2017年成都市行政区域内精神卫生医疗机构的床位、人力资源、业务开展情况等进行调查。 结果 2017年成都市实有开设精神科并开展业务的医疗机构共60家,编制床位数4 503张,床位密度3.14张/万人,分别较2012年增长了43.73%、17.60%;实有床位数9 647张,床位密度为6.65张/万人,分别较2012年增长了82.09%、47.12%。2017年成都市精神卫生医疗机构有精神科医生677人（4.71人/每10万人）、精神科护士1 511人（10.53人/每10万人）,分别较2012年增长了2.17%、5.94%。2017年成都市精神科共接收门诊患者792 874人次,住院患者43 981人次,分别较2012年增长了76.09%、78.08%。平均每名精神科医生年负担门诊患者1 171人次、住院患者65人次,分别较2012年增长了40.75%、41.30%。 结论 与2012年相比,2017年成都市的精神卫生医疗机构数量急增;精神科开放床位数量已可以满足中等需求,精神科医疗服务量明显增加,但精神科医护人员并无明显增长。     

Incidence and Direct Medical Cost of Adjustment Disorder and in Korea Using National Health Insurance Service Claims Data From 2011 to 2017

ObjectiveWe aimed to investigate the annual incidence and direct medical cost of adjustment disorder in general population using the National Health Insurance Service Database (NHID) in Korea. MethodsTo examine the incidence, we selected patients who had at least one medical claim for adjustment disorder and had not been diagnosed in the previous 365 days, from 2010 to 2017. ResultsThe number of newly diagnosed cases of adjustment disorder from 2011 to 2017 were total 101,922. Annual incidence of adjustment disorder was ranged from 22.0 to 36.8 per 100,000 persons. The incidence of adjustment disorder was found more in female and highest among 70–79 years of age group and medical aid beneficiaries group. Annual prevalence of adjustment disorder was in the range from 95.4 to 116.4 per 100,000 persons. Estimated annual medical cost per person of adjustment disorder was ranged from 162 to 231.4 US dollars.ConclusionFrom 2011 to 2017, the annual incidence and direct medical cost of adjustment disorder in Korea were increased. Proper information on adjustment disorder will not only allows us to accumulate more knowledge but also lead to more appropriate therapeutic interventions.     

Assessing the reliability,predictive and construct validity of historical,clinical and risk management-20 (HCR-20) in Mexican psychiatric inpatients

Introduction: Assessing dangerousness to gauge the likelihood of future violent behaviour has become an integral part of clinical mental health practice in forensic and non-forensic psychiatric settings, one of the most effective instruments for this being the Historical, Clinical and Risk Management-20 (HCR-20). Objective: To examine the HCR-20 factor structure in Mexican psychiatric inpatients and to obtain its predictive validity and reliability for use in this population. Method: In total, 225 patients diagnosed with psychotic, affective or personality disorders were included. The HCR-20 was applied at hospital admission and violent behaviours were assessed during psychiatric hospitalization using the Overt Aggression Scale (OAS). Construct validity, predictive validity and internal consistency were determined. Results: Violent behaviour remains more severe in patients classified in the high-risk group during hospitalization. Fifteen items displayed adequate communalities in the original designated domains of the HCR-20 and internal consistency of the instruments was high. Conclusion: The HCR-20 is a suitable instrument for predicting violence risk in Mexican psychiatric inpatients.     

住院精神障碍患者家属照护过程的质性研究——基于生物生态学理论

目的探讨住院环境下家属对精神障碍患者的照护过程,为医院的环境设置和患者的照护提出改进思路。方法采用质性研究互动模式设计,在住院病房进行观察,选取家属、患者和医护人员共8人进行深度访谈,并结合类属分析与情境分析对资料进行整合和描述。结果基于生物生态学理论分析发现,家属对住院精神障碍患者的照护是一种特殊的再社会化,在这一过程中,家属增进对疾病的理解、调整并适应照护角色、适应住院环境。结论家属、医护人员和社会应通力合作,为家属更明确、积极地参与到照护过程创造良好的环境。     

Association of insomnia disorder with sociodemographic factors and poor mental health in COVID-19 inpatients in China

PurposeTo examine insomnia disorder and its association with sociodemographic factors and poor mental health in 2019 novel coronavirus (COVID-19) inpatients in Wuhan, China.Designand Methods: A total of 484 COVID-19 inpatients in Wuhan Tongji Hospital were selected and interviewed with standardized assessment tools. Insomnia disorder was measured by the Chinese version of the Insomnia Severity Index (ISI-7), a total score of 8 or more was accepted as the threshold for diagnosing insomnia disorder.ResultsThe prevalence of insomnia disorder in the whole sample was 42.8%. Binary logistic regression analysis revealed that female gender, younger age, and higher fatigue and anxiety severity were more likely to experience insomnia disorder.ConclusionGiven the high rate of insomnia disorder status among COVID-19 inpatients in Wuhan, China, and its negative effects, follow-up assessments and appropriate psychological interventions for insomnia disorder are needed in this population.     

内科住院患者抑郁障碍现状及相关因素的横断面研究

目的探讨内科住院患者抑郁障碍的发生率、内科医师的识别率及其可能的影响因素。方法采用横断面的研究方法，首先应用ZUNG氏抑郁自评量表（SDS）对符合入组条件的371例内科住院患者进行筛查，对筛查阳性者（SDS粗分≥40分）和209／6的筛查阴性者（SDS粗分〈40分），再以美国《精神障碍诊断与统计手册第四版》DSM-Ⅳ作为金标准进行抑郁症的诊断，估算抑郁障碍的发生率及内科医师的识别率，并对相关的因素进行分析。结果内科患者抑郁检出率为占37．34％；SDS筛选阳性者118人和随机抽查20％的SDS筛选阴性者40人中经SCID诊断，现患抑郁障碍者共120人。内科医师识别率仅为3．33％。单因素分析发现：性别、年龄、文化程度、经济状况、躯体疾病既往史、住院时间、病程与抑郁的发生有关。多因素Logistic回归分析显示：性别、年龄、经济状况、疾病复发情况及住院时间是影响抑郁发生的主要因素。结论内科住院患者抑郁发生率高。性别、年龄、经济状况、疾病复发情况及住院时间是主要的影响因素。内科医师识别率低，提高内科医师对抑郁症的识别率和治疗率是当务之急。     

The utility of neuropsychological consultation in identifying medical inpatients with suspected cognitive impairment at risk for greater hospital utilization

Objective: This was a retrospective study designed to examine the relationship between inpatient neuropsychological status and future utilization costs. Methods: We completed a retrospective chart review of 280 patients admitted to a large academic medical center who were referred for bedside neuropsychological evaluation. Patients were grouped based on neuropsychological recommendation regarding level of supportive needs post-discharge (low, moderate, high). Level of support was used as a gross surrogate indicator of cognitive status in this heterogeneous sample. We also included patients who refused assessment. Outcome variables included time to readmission, number of emergency department visits, inpatient admissions, length of hospitalization, and total costs of hospitalizations, 30 days and 1 year following discharge. Results: Multivariate analysis indicated patients who refused assessment had higher inpatient service utilization (number of ED visits, number of admissions, and total cost of hospitalization) compared to those with moderate needs. Also, high needs patients had higher total cost of hospitalization at 1 year, and those with low needs used the ED more, compared to those with moderate needs. Conclusions: Our findings replicate prior studies linking refusal of neuropsychological evaluation to higher service utilization costs, and suggest a nonlinear relationship between cognitive impairment severity and future costs for medical inpatients (different groups incur different types of costs). Results preliminarily highlight the potential utility of inpatient neuropsychological assessment in identifying patients at risk for greater hospital utilization, which may allow for the development of appropriate interventions for these patients.     

糖皮质激素治疗多发性硬化不同方案的临床应用

目的探讨糖皮质激素治疗多发性硬化(MS)的不同方案的疗效、住院费用、住院时间、复发情况及不良反应等。方法 97例MS急性期患者随机分为鞘内注射甲泼尼龙(MPS)组(30例)、MPS冲击治疗组(36例)及地塞米松治疗组(31例),比较各组治疗后不同时间的Kurtzke扩展致残量表(EDSS)评分减少值、住院费用、费用中药品比例、住院时间、复发情况及不良反应等。结果鞘内注射MPS组治疗后5 d起,MPS冲击治疗组治疗后10 d起EDSS评分减少值明显高于地塞米松治疗组(均P<0.05)。治疗后5 d时鞘内注射MPS组EDSS评分减少值明显高于MPS冲击治疗组(P<0.05)。3组间鞘内注射MPS组总住院费用最少,费用中药品比例最低,日均住院费用较少,住院时间较短(均P<0.05);MPS冲击治疗组日均住院费用最高,地塞米松治疗组住院时间最长(均P<0.05)。MPS冲击治疗组复发率最高,复发时间最短(均P<0.05);地塞米松治疗组和鞘内注射MPS组复发率及复发时间比较差异无统计学意义。各组均无严重不良反应发生。结论鞘内注射MPS治疗MS起效较快,近期疗效显著,住院费用较低,复发率较低,复发时间较长,无严重不良反应,宜在临床推广应用。     

Prospective Interventions to Reduce Stroke Care Variation in a Hub-and-Spokes System

BackgroundCare variation reduction (CVR) is a central objective of quality management to decrease wasted spending.ObjectiveTo analyze stroke care variation at a hub-and-spokes system and determine interventions to prospectively reduce unwarranted variation.MethodsIn this prospective cohort single arm intervention study providers were blinded to pre-specified endpoints. Care variation was measured for DRGs 61-66 and 69 in USD, and severity level by Case Mix Index (CMI) by provider. A multi-disciplinary task force chaired by Vascular Neurologist analyzed data extracted from Crimson, a patient centric data analysis tool, and determined interventions. The primary measure outcome was change in CMI post intervention.ResultsAnnualized baseline care variation was $ 0.7-1.2M (2017) in a drip-and-ship thrombolytic treatment model within the hub-and-spokes system. Pharmacy expenses contributed to 42% of variation followed by laboratory 12%, physical therapy 11%, supplies 11% and imaging 9%. Interventions to achieve CVR were prospectively implemented in 2018 and CVR was measured in January 2019. Based on 2017 CMI of 1.28, the goal of intervention was set to achieve 7% increase to 1.37 with projected increased revenue of $774,144. After implementation of interventions the actual achieved average CMI in 2018 was 1.40 paralleled by improvement in secondary outcomes of length of stay, observed over expected mortality and re-admission.ConclusionsA drip-and-ship stroke model within a single hub-and-spokes healthcare system can achieve substantial reduction in care variation and associated cost along with improvement in patient care indicators.     

Investigating Medical Cost and Mortality Among Psychiatric Patients Involuntary Admissions: A Nationwide Propensity Score-Matched Study

Objective Involuntary admission to psychiatric inpatient care can protect both patients with severe mental illnesses and individuals around them. This study analyzed annual healthcare costs per person for involuntary psychiatric admission and examined categories of mental disorders and other factors associated with mortality. Methods This retrospective cohort study collected 1 million randomly sampled beneficiaries from the National Health Insurance Database for 2002–2013. It identified and matched 181 patients with involuntary psychiatric admissions (research group) with 724 patients with voluntary psychiatric admissions (control group) through 1:4 propensity-score matching for sex, age, comorbidities, mental disorder category, and index year of diagnosis. Results Mean life expectancy of patients with involuntary psychiatric admissions was 33.13 years less than the general population. Average annual healthcare costs per person for involuntary psychiatric admissions were 3.94 times higher compared with voluntary admissions. The general linear model demonstrated that average annual medical costs per person per compulsory hospitalization were 5.8 times that of voluntary hospitalization. Survival analysis using the Cox proportional hazards model found no significant association between type of psychiatric admission (involuntary or voluntary) and death. Conclusion This study revealed no significant difference in mortality between involuntary and voluntary psychiatric admissions, indicating involuntary treatment’s effectiveness.