精神科醫院急性病房自動出院之預測因子

Predictors of Discharge against Medical Advice from the Acute Wards of a Psychiatric Hospital

郭建成(Chien-Cheng Kuo) ； 崔秀倩(Hsiu-Chien Tsui) ； 沈淑華(Su-Hwa Shen) ； 林麗娟(Li-Chuan Lin) ； 唐心北(Hsin-Pei Tang) ； 張達人(Ta-Jen Chang)

《台灣精神醫學》 19卷2期 (2005/06) Pp. 128-136

https://doi.org/10.29478/TJP.200506.0006

摘要

目的：本研究主要為了找出精神專科教學醫院急性病房自動出院的預測因子。方法：以病歷回顧方式，比較2003年1月1日至2003年12月31日自動出院病患共58人次及非自動出院病患共706人次，兩組病患之特性。分析變項包括社會人口學資料和臨床特質。結果：入院前有職業(OR=2.43)、無重大傷病卡(OR=2.24)、星期五或星期六入院(OR=2.47)及住院病房為兼急診業務的病房(OR=2.66)，為邏輯迴歸後有統計顯著差異的預測因子，病患若同時有3個或更多的預測因子，則自動出院的可能性是非自動出院的7.6倍。年齡較輕、罹病無數較短、診斷為未明示精神病及經由急診入院，亦和自動出院有關，但於邏輯迴歸後並未進入預測模式。結論：影響自動出院的因素不僅和病患本身的特質有關，而且可能和病房的運作效率及照護的強度有關。

關鍵字

自動出院 ； 精神科住院病患 ； 危險因子 ； 照護品質

並列摘要

Objectives: This study explored the predictors of discharge against medical advice (DAMA) from the acute wards of a psychiatric teaching hospital. Methods: The demographic and clinical characteristics of 58 patients with DAMA and 706 patients without DAMA were compared using data obtained by chart review during the period between January 1 and December 31, 2003. Results: The significant predictors of the DAMA by logistic regression were currently employed before admission (OR=2.43), no major illness certificate (OR=2.24), admission on Friday or Saturday (OR=2.47), and the ward of admission concurrently in charge of emergency (OR=2.66). Patients with 3 or more predictors had a likelihood of the DAMA which was 7.6 fold that of patients without DAMA. Other factors significantly related to DAMA in the univariate analysis were young age, shorter duration of illness, diagnosis of psychotic disorder not otherwise specified, and admission from the emergency room, but these variables were not included in the predicting model after logistic regression. Conclusion: This study found that the factors that influenced the DAMA were not only related to the characteristics of the patients but also likely related to the operational efficiency and intensity of care at various wards.

並列關鍵字

discharge against medical advice ； psychiatric inpatients ； risk factors ； quality of care

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