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Mental disorder and health care utilization among primary care center patients.

机译:初级保健中心患者的精神障碍和卫生保健利用率。

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摘要

To identify the important risk factors that contribute to the skewed health care utilization rates among patients, where the top percent of patients consume the majority of medical services, we recruited 334 study participants from Yale New Haven Hospital (YNHH) Primary Care Center. Those patients were chosen based on their health care utilization one year prior to the study so that roughly 50% of these patients will present top 20% costly of all YNHH patients. These patients were interviewed three times over the course of a year to get measurements on various instruments such as demographic characteristics, health status, mental disorder diagnosis and psychosocial measurements. In our analysis, study participants were stratified into four utilization categories base on their utilization data during the year of study: Low (below 50% in total cost); middle (50% to 75% in total costs); high (75% to 95% in total costs); and super high (highest 5% in total cost). Difference in demographic characteristics and instrument measurements between utilization categories were compared using analysis of variance (ANOVA), chi-square tests, or fisher's exact tests. Multivariate regression analysis and recursive partitioning tree analysis were performed to identify the important predictors of health care utilization. Results show that there may be a gender linked increased risk for high utilization to a degree. Age, employment status, who do you live with, Interpersonal Support Evaluation List (ISEL) score and physical health score (SF36) differ significantly between different utilization groups. Results from multivariate regression analysis indicate that among all variables, physical health score (SF36) is the most important predictor for health care utilization, followed by SCID diagnosis. Whereas recursive partitioning tree analysis shows that among patients who have lower physical health scores, those who have a current SCID diagnosis have higher average health care cost compared to patients who do not have a current SCID diagnosis, which may be explained by that primary care patients with psychiatric disorders often over present with physical impairments than those associated with medical diagnosis.
机译:为了确定导致患者中医疗保健利用率偏低的重要风险因素,其中最高比例的患者使用大部分医疗服务,我们从耶鲁纽黑文医院(YNHH)初级保健中心招募了334名研究参与者。这些患者是根据研究前一年的医疗保健利用情况选择的,因此,这些患者中约有50%会占所有YNHH患者费用的前20%。一年中对这些患者进行了三次访谈,以通过各种手段进行测量,例如人口统计特征,健康状况,精神障碍诊断和社会心理测量。在我们的分析中,研究参与者根据研究年度的利用数据将其分为四个利用类别:低(总成本低于50%);中级(总费用的50%到75%);高(总成本的75%至95%);和超高(总费用的最高5%)。使用方差分析(ANOVA),卡方检验或费舍尔精确检验比较使用类别之间的人口统计学特征和仪器测量差异。进行了多元回归分析和递归分区树分析,以确定卫生保健利用率的重要预测指标。结果表明,在某种程度上,性别相关的高利用风险可能增加。不同的使用率组之间,年龄,就业状况,与谁住在一起,人际支持评估表(ISEL)分数和身体健康分数(SF36)明显不同。多元回归分析的结果表明,在所有变量中,身体健康评分(SF36)是最重要的卫生保健利用预测指标,其次是SCID诊断。递归分区树分析显示,在身体健康评分较低的患者中,具有当前SCID诊断的患者与没有当前SCID诊断的患者相比,其平均医疗保健费用更高,这可能由初级保健患者解释患有精神疾病的人通常比与医学诊断有关的人存在身体上的障碍。

著录项

  • 作者

    Tang, Xiaoqing.;

  • 作者单位

    Yale University.;

  • 授予单位 Yale University.;
  • 学科 Biology Biostatistics.;Health Sciences Public Health.
  • 学位 M.P.H.
  • 年度 2010
  • 页码 30 p.
  • 总页数 30
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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