the impact of mental illness on potentially preventable hospitalisations a population-based cohort study精神疾病影响潜在可预防住院治疗上以人群为基础的队列研究.pdf

Mai et al. BMC Psychiatry 2011, 11:163 /1471-244X/11/163 RESEARCH ARTICLE Open Access The impact of mental illness on potentially preventable hospitalisations: a population-based cohort study 1* 1 1 2 Qun Mai , C D’Arcy J Holman , Frank M Sanfilippo and Jonathan D Emery Abstract Background: Emerging evidence indicates an association between mental illness and poor quality of physical health care. To test this, we compared mental health clients (MHCs) with non-MHCs on potentially preventable hospitalisations (PPHs) as an indicator of the quality of primary care received. Methods: Population-based retrospective cohort study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia from 1990 to 2006, using linked data from electoral roll registrations, mental health registry (MHR) records, hospital inpatient discharges and deaths. We used the electoral roll data as the sampling frame for both cohorts to enhance internal validity of the study, and the MHR to separate MHCs from non-MHCs. Rates of PPHs (overall and by PPH category and medical condition) were compared between MHCs, category of mental disorders and non-MHCs. Multivariate negative binomial regression analyses adjusted for socio-demographic factors, case mix and the year at the start of follow up due to dynamic nature of study cohorts. Results: PPHs accounted for more than 10% of all hospital admissions in MHCs, with diabetes and its complications, adverse drug events (ADEs), chronic obstructive pulmonary disease (COPD), convulsions and epilepsy, and congestive heart failure being the most common causes. Compared with non-MHCs, MHCs with any mental disorders were more likely to experience a PPH than non-MHCs (overall adjusted rate ratio (ARR) 2.06, 9