This longitudinal study identified risk factors for frequency of hospitalization among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis. Records of n = 11,367 patients were investigated using administrative databanks (2012–13/2014–15). Hospitalization rates in the 12 months after a first ED visit in 2014–15 were categorized as no hospitalizations (0 times), moderate hospitalizations (1–2 times), and frequent hospitalizations (3+ times). Based on the Andersen Behavioral Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014–15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalization rate. Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalizations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12–17 years) were risk factors for moderate hospitalizations, while higher numbers (4+) of overall interventions in local community health service centers were a risk factor for frequent hospitalizations only. Patients with personality disorders, drug-related disorders, suicidal behaviors, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalized. Less urgent and non-urgent illness acuity prevented moderate hospitalizations only. Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalizations as compared with non-hospitalized patients. Patients at risk for frequent hospitalizations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalization.

中文翻译：

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在急诊科就精神健康状况进行过就诊的患者中，任何疾病的住院风险因素。

这项纵向研究确定了以前曾到过魁北克（加拿大）六个急诊科（ED）至少一次就精神健康（MH）状况进行过一次就诊的任何疾病患者的住院频率危险因素作为主要诊断。使用行政数据库（2012–13 / 2014–15）调查了n = 11,367名患者的记录。在2014-15年度首次就诊急诊后的12个月内，住院率分为无住院（0次），中度住院（1-2次）和频繁住院（3次以上）。根据Andersen行为模型，在2014-15年首次访问之前的两年中，收集了有关风险因素的数据，并将其确定为诱发因素，促成因素或需求因素。根据三组住院率，使用分层多项式逻辑回归对他们进行了测试。在研究模型中，促成因素占总方差的最大百分比，其次是需求和诱发因素。并发精神障碍（MD）/物质相关障碍（SRD），酒精相关障碍，抑郁症，与门诊精神病医生的咨询频率，事先就任何医疗状况进行过ED访视以及接受专科护理的医生人数都有风险中度和频繁住院的因素。精神分裂症谱图和其他精神病，双相情感障碍和年龄（12-17岁除外）是中度住院的危险因素，而在当地社区卫生服务中心中进行干预的人数较多（4+）仅是频繁住院的危险因素。人格障碍，药物相关疾病，自杀行为的患者，以及在单独的地点就诊过普通ED的精神科ED的患者，或没有精神科服务就诊的普通ED的患者，住院的可能性也较小。较紧急和较不紧急的疾病敏锐度只能阻止中等程度的住院治疗。与未住院的患者相比，患有严重且复杂的健康状况的患者以及接受过更多门诊精神病医生咨询和急诊就诊的患者，其住院的中度和频度更高。具有经常住院风险的患者总体上更脆弱，并且具有重要的生物心理社会问题。改善初级保健和综合门诊服务可以防止急诊后住院。