Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS), Global Assessment of Functioning (variation and at discharge) and Clinical Global Impression (severity and improvement) were used to build a ten-point improvement index (I-Index). Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes) were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

背景 综合医院精神科病房在精神卫生保健体系中具有至关重要的基础性地位。然而，目前针对此类医疗机构内患者病情改善水平的相关研究仍较为匮乏。
目的 采用由易于测量的临床参数构建的评分指标，评估精神科住院患者出现良好与不良转归的相关影响因素。
方法 选取住院时长（Length of Stay, LOS）、功能大体评定量表（Global Assessment of Functioning, GAF，包含变化值与出院时得分）以及临床大体印象量表（Clinical Global Impression, CGI，包含严重程度与改善情况），构建十分制病情改善评分指标（I-Index）。回顾分析某综合医院18个月内收治的精神科住院患者的病历资料，根据临床与社会人口学变量，采用单因素与多因素模型对不良、中等、良好转归三组患者进行对比分析。
结果 本研究共纳入250例患者，不良、中等与良好转归组的占比分别为16.4%、59.6%与24.0%。出院时出现不良转归的相关危险因素主要包括受教育程度较低、一过性残疾、使用抗精神病药物、以「行为改变/攻击性」为主诉以及存在精神病性特征。多因素分析结果显示，与良好转归组相比，不良转归组中「精神病性障碍」与「人格障碍」诊断以及其他相关变量的比值比（Odds Ratio, OR）更高。
讨论 本研究构建的I-Index相较于仅以住院时长作为评估指标，能够为住院患者转归评估提供更为简便且全面的量化依据。针对精神病性障碍及存在行为紊乱/攻击性主诉的患者，需制定差异化的干预方案。