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Medical and Psychiatric Characteristics of Patients Hospitalized for Severe Restrictive Eating Disorders: Analysis of 545 Consecutive Patients with Severe Anorexia Nervosa or Avoidant/Restrictive Food Intake Disorder 因严重限制性进食障碍而住院的患者的医学和精神特征。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-07-01 DOI: 10.1016/j.jaclp.2024.02.001

Background

People with severe eating and feeding disorders regularly require hospitalization due to complications inherent to their disease, though formal training regarding this care is limited.

Methods

This retrospective study included 545 patients with severe anorexia nervosa (AN) or avoidant restrictive food intake disorder hospitalized in a medical stabilization unit between 2018 and 2021. Biometrics were obtained throughout hospitalization. Nutrition was increased until patients were gaining 0.2 kg/day.

Results

Average admission body mass index was 13 kg/m2 with diagnoses of 46% AN-R (restricting), 39% AN-BP (binge-purge), and 15% avoidant restrictive food intake disorder. Average daily Kcals by discharge were 3343 for females and 3962 for males; 26% required nasogastric feeding. Hypoglycemia was common until day 7, correlated with elevated liver function tests and low prealbumin. Liver function tests were abnormal in 31% of patients. Refeeding hypophosphatemia developed in 26% of patients starting day 2 and was associated with lower body mass index. Hypokalemia appeared on admission among 39%, twice as common in patients diagnosed with AN-BP. Initial electrocardiograms were abnormal in 50% of patients, usually sinus bradycardia. Average QTc was normal, but only 14% prolonged. Bone density testing revealed 70% osteoporosis. History of suicide attempts were present in 19%, while 76% and 50% presented with anxiety and depressive disorders, respectively.

Conclusions

Given the inextricability of medical complications from severe eating and feeding disorders, familiarity among consult-liaison psychiatrists with the prevalence of frequently observed abnormal findings can inform consultation, prevent adverse events, prevent unnecessary intervention, and facilitate weight restoration and medical stabilization.

背景:严重进食和进食障碍患者因其疾病固有的并发症经常需要住院治疗,但有关这种护理的正规培训却很有限:这项回顾性研究纳入了2018年至2021年期间在医疗稳定病房住院的545名严重神经性厌食症(AN)或回避性限制性食物摄入障碍(ARFID)患者。住院期间全程采集生物计量学数据。增加营养,直到患者每天增加 0.2 千克:入院时平均体重指数(BMI)为 13 kg/m2,诊断结果为:46% AN-R(限制型)、39% AN-BP(暴饮暴食型)和 15% ARFID。出院时,女性的日均热量为 3,343 千卡,男性为 3,962 千卡;26% 的患者需要鼻饲。低血糖在第 7 天之前很常见,与肝功能检测(LFT)升高和低白蛋白有关。31% 的患者 LFT 异常。从第 2 天开始,26% 的患者出现再喂养性低磷血症,并与较低的体重指数有关。39%的患者在入院时出现低钾血症,是确诊为 AN-BP 患者的两倍。50%的患者初始心电图异常,通常为窦性心动过缓。平均 QTc 正常,只有 14% 的患者 QTc 延长。骨密度检测显示,70%的患者患有骨质疏松症。19%的患者有自杀企图,76%和50%的患者分别患有焦虑症和抑郁症:鉴于严重进食和喂养障碍的医疗并发症是不可分割的,CL 精神科医生熟悉经常观察到的异常结果的发生率可以为咨询提供参考,防止不良事件和不必要的干预,促进体重恢复和医疗稳定。
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引用次数: 0
Potential Application of Ketamine in Pain and Withdrawal in Patients With Opioid Use Disorder 为会诊联络精神科医生提供氯胺酮:应用于阿片类药物使用障碍。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-07-01 DOI: 10.1016/j.jaclp.2024.04.004
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引用次数: 0
The Frequency and Impact of Adverse Childhood Experiences on Mood, Alcohol Relapse, and Outcomes in Liver Transplantation: A Retrospective Cohort Study. 童年不良经历的频率及其对肝移植患者的情绪、酒精复发和预后的影响:一项回顾性队列研究
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-06-26 DOI: 10.1016/j.jaclp.2024.06.006
David C Fipps, Tyler Nguyen, Rachel Meyer, Byron Smith, Richard Roden, Matthew M Clark, Kymberly D Watt, Sheila G Jowsey-Gregoire

Background: Adverse childhood experiences (ACEs) are associated with the development of negative health behaviors and medical illnesses. ACE's association with poor health outcomes has been well documented in the general population; however, this relationship remains less clear in liver transplant (LT) recipients.

Objective: The aims of this study were to determine the prevalence of ACE and the influence of ACE on LT outcomes.

Methods: A retrospective electronic medical record review of all LT recipients over 11 years at an academic LT center. Demographic, diagnostic, and disease characteristics were extracted and compared for a history of ACE. Associations between a history of ACE and extracted variables were statistically tested using Student's t-test, chi-square tests, or Fisher's exact test, where appropriate. Graft and patient survival were tested using log-rank tests.

Results: Of the 1172 LT recipients, 24.1% endorsed a history of ACE. Females (P = 0.017) and recipients with lower levels of education (P < 0.001) had a higher frequency of ACE. Those with a history of ACE had a higher prevalence of hepatitis C virus (P < 0.001) and higher pretransplant body mass index (P < 0.001). Recipients with a history of ACE had higher prevalence of mood (P < 0.001), anxiety (P < 0.001), post traumatic stress disorder (P < 0.001), alcohol use (P < 0.001), and cannabis use (P < 0.001) disorders, as well as higher Patient Health Questionnaire-9 (P < 0.001) and General Anxiety Disorder-7 (P < 0.001) scores pre- and post-transplant. Those with ACE had a higher incidence of recorded relapses to alcohol by 3 years post-transplant (P = 0.027). Mean lab values, graft survival, and patient survival were not significantly different between those with and without a history of ACE except for total bilirubin at 6 months (P = 0.021).

Conclusions: One-quarter of LT recipients have experienced ACE. ACE was associated with a history of psychiatric diagnoses, substance use disorders, elevated Patient Health Questionnaire-9 and General Anxiety Disorder-7 scores, and a higher prevalence of relapse to alcohol use after transplant. This population may benefit from increased/improved access to appropriate mental health and substance use services and support in the peri- and post-transplant period.

简介童年不良经历(ACE)与不良健康行为和医疗疾病的发生有关。在普通人群中,ACE与不良健康后果的关系已得到充分证实;但在肝移植(LT)受者中,这种关系仍不太明确。因此,本研究旨在确定ACE的患病率以及ACE对LT预后的影响:方法:对一家学术性肝移植中心11年来的所有LT受者的电子病历进行回顾性分析。方法:对一家学术性肝移植中心11年来的所有LT受者的电子病历进行回顾性分析,提取人口统计学特征、诊断特征和疾病特征,并对ACE病史进行比较。采用学生 t 检验、卡方检验或费雪精确检验对 ACE 病史与所提取变量之间的相关性进行统计检验。使用对数秩检验对移植物和患者的存活率进行检验:在1172名LT受者中,24.1%的受者有ACE病史。女性(p = 0.017)和受教育程度较低(p < 0.001)的受者出现 ACE 的频率较高。有 ACE 病史的受者感染 HCV 的几率更高(p < 0.001),移植前的体重指数更高(结论:四分之一的 LT 受者有 ACE 病史:四分之一的LT受者经历过ACE。ACE与精神病诊断史、药物使用障碍、PHQ-9和GAD-7评分升高以及移植后酗酒复发率较高有关。在移植前和移植后,增加/改善获得适当的心理健康和药物使用服务和支持的途径可能会使这一人群受益。
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引用次数: 0
Preteen Suicide Risk Screening in the Pediatric Outpatient Setting: A Clinical Pathway. 儿科门诊中的青少年自杀风险筛查:临床路径。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-06-21 DOI: 10.1016/j.jaclp.2024.06.003
Laura Hennefield, Ellen-Ge Denton, Peggy G Chen, Arielle H Sheftall, Lynsay Ayer

We are in a youth mental health crisis with unprecedented and staggeringly high rates of suicidal ideations and suicide behaviors in preteens. In the United States, 14.5% of children aged 9-10 have experienced suicidal thoughts and behaviors, including 1.3% with a suicide attempt. American Academy of Pediatrics guidelines call for universal suicide risk screening of youth aged 12 years and older during preventative health care visits and screening in preteens aged 8-11 years when clinically indicated. However, what constitutes a clinical indication at 8-11 years can be difficult to systematically detect, and pediatric practitioners may not be equipped with necessary age-specific assessment tools. This is compounded by the lack of emphasis on preteen suicide risk screening (and focus on adolescents), which leaves practitioners without age-appropriate resources to make clinical determinations for at-risk preteens. The objective of this project was to develop an evidence-informed suicide risk screening pathway for pediatric practitioners to implement with preteen patients in outpatient settings. Suicide risk assessment in younger children (<8 years) is also briefly addressed. We convened a group of researchers and practitioners with expertise in preadolescent suicide, pediatric medicine, behavioral health screening integration with primary care, and child development. They reviewed the empirical literature and existing practice guidelines to iterate on a multi-informant clinical suicide risk screening pathway for preteens that includes both caregivers and preteens in the screening process. We also developed tools and accompanying guidelines for a preteen suicide risk screening workflow and risk determination to aid practitioners in deciding who, when, and how to screen. Finally, we provide scripts for introducing suicide risk screening to caregivers and preteens and to discuss screening findings.

我们正处于一场青少年心理健康危机之中,青少年自杀念头和自杀行为的发生率之高前所未有,令人震惊。在美国,14.5% 的 9-10 岁儿童有过自杀念头和行为,其中 1.3% 有过自杀企图。美国儿科学会的指导方针要求在预防性保健就诊时对 12 岁以上的青少年进行普遍的自杀风险筛查,并在有临床指征时对 8-11 岁的学龄前儿童进行筛查。然而,什么是 8-11 岁的临床指征可能很难系统地检测,儿科医生可能也没有配备必要的特定年龄评估工具。此外,由于缺乏对学龄前儿童自杀风险筛查的重视(而将重点放在青少年身上),这使得从业人员在对高危学龄前儿童进行临床判断时缺乏与年龄相适应的资源。因此,本项目的目的是为儿科从业人员开发一种有实证依据的自杀风险筛查途径,以便在门诊环境中对青少年患者实施筛查。低龄儿童自杀风险评估
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引用次数: 0
Pediatric Behavioral Health Nursing Consultation: An Innovative Approach to Mental Healthcare for Hospitalized Youth. 儿科行为健康护理咨询:为住院青少年提供心理保健的创新方法。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-06-14 DOI: 10.1016/j.jaclp.2024.06.002
Claire Fanning, Renee Grooters, Nasuh Malas
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引用次数: 0
Impact of the COVID-19 Pandemic on the Mental Health of Patients Presenting to the Child and Adolescent Psychiatric Consultation-Liaison Service in a Large Urban Hospital. COVID-19 大流行对一家大型城市医院儿童和青少年精神科咨询联络服务处就诊患者心理健康的影响。
IF 2.3 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-05-15 DOI: 10.1016/j.jaclp.2024.05.002
Jane Miles, Jessica M Jones, Kennedy M Balzen
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引用次数: 0
Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study. 左心室辅助装置(LVAD)植入术后谵妄的预后影响:一项回顾性研究。
IF 2.3 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-05-03 DOI: 10.1016/j.jaclp.2024.04.005
Paul Noufi, Kelley M Anderson, Nancy Crowell, Yasmine White, Ezequiel Molina, Sriram D Rao, Hunter Groninger

Background: In critically ill patients, delirium is a prognostic indicator of morbidity and mortality.

Objective: This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation.

Methods: This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared preimplantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as reintubation rate, length of stay, discharge disposition, and readmission rates.

Results: In total, 361 patients (26.7% women and 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Preimplantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P = 0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P = 0.007), 6-month (P = 0.004), and in-hospital mortality (P < 0.001), unplanned reintubations (P < 0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and intensive care unit length of stay were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to the hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant.

Conclusions: In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse postsurgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.

导言:谵妄是危重病人发病率和死亡率的预后指标。本研究探讨了谵妄诊断对左心室辅助装置(LVAD)植入术后预后的影响:这项回顾性研究纳入了 2016 年 1 月至 2020 年 12 月期间在我院接受 LVAD 的所有成年患者。我们比较了有谵妄诊断和无谵妄诊断两组患者的植入前特征,并比较了他们的预后,包括1个月、6个月和院内死亡率,以及再插管率、住院时间(LOS)、出院处置和再入院率:共有 361 名患者(26.7% 为女性,75.8% 为非裔美国人)接受了耐用型 LVAD。94名患者(26.1%)在入院时被诊断为谵妄。植入前的人口统计学特征、既往医疗和精神状况、机械辅助循环支持机构间登记(INTERMACS)档案以及实验室值在诊断出谵妄和未诊断出谵妄的两组患者之间没有差异;年龄较大(59 岁对 56 岁;P=0.03)与谵妄有关。谵妄诊断与较高的1个月死亡率(P=0.007)、6个月死亡率(P=0.004)和院内死亡率有关(结论:谵妄诊断与较高的1个月死亡率(P=0.007)、6个月死亡率(P=0.004)和院内死亡率有关):在这项研究中,在 LVAD 植入术入院期间诊断出谵妄与较高的死亡率、不良的术后结果和不利的出院处置有关。未来需要进行前瞻性研究,以验证谵妄对短期和长期预后的影响。此外,还需要确定与谵妄相关的可改变的风险因素,以促进早期诊断并实施循证管理策略,从而改善该人群的预后。
{"title":"Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study.","authors":"Paul Noufi, Kelley M Anderson, Nancy Crowell, Yasmine White, Ezequiel Molina, Sriram D Rao, Hunter Groninger","doi":"10.1016/j.jaclp.2024.04.005","DOIUrl":"10.1016/j.jaclp.2024.04.005","url":null,"abstract":"<p><strong>Background: </strong>In critically ill patients, delirium is a prognostic indicator of morbidity and mortality.</p><p><strong>Objective: </strong>This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation.</p><p><strong>Methods: </strong>This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared preimplantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as reintubation rate, length of stay, discharge disposition, and readmission rates.</p><p><strong>Results: </strong>In total, 361 patients (26.7% women and 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Preimplantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P = 0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P = 0.007), 6-month (P = 0.004), and in-hospital mortality (P < 0.001), unplanned reintubations (P < 0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and intensive care unit length of stay were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to the hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant.</p><p><strong>Conclusions: </strong>In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse postsurgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Tremor Classification Primer for the Consultation-Liaison Psychiatrist 为会诊联络精神科医生编写的震颤分类入门指南。
IF 2.3 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.03.007
Drew Cumming M.D., Mirza Baig M.D., David L. Perez M.D., M.M.Sc.
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引用次数: 0
Changes in Serum Concentration of Antidepressants After Bariatric Surgery and Recommendations for Postbariatric Surgery Antidepressant Therapy 减肥手术后抗抑郁药血清浓度的变化以及减肥手术后抗抑郁治疗的建议。
IF 2.3 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.01.001
Daniel Maass M.D. , Drew Cumming M.D. , Haniya Raza D.O. , Ted Liao M.D. , Joyce Chung M.D. , Maryland Pao M.D.

Background

Bariatric surgery affects the absorption of medications including antidepressants, but data regarding these effects are limited.

Objectives

Our objectives were to review publicly available data regarding changes in antidepressant serum concentration following bariatric surgery in order to develop medication dosing recommendations in this patient population.

Methods

A comprehensive literature review was performed utilizing key search terms in Pubmed. Additional data were retrieved from the Food and Drug Administration and DrugBank Online resources.

Results

A total of twelve published articles were included in addition to the publicly available data from the Food and Drug Administration and DrugBank. The serum concentration of antidepressants following bariatric surgery demonstrated considerable variability between and within drug classes due to unique pharmacokinetic features, drug preparation, and formulation. Recommendations were developed from published data regarding changes in serum concentration and drug-specific pharmacokinetic data.

Conclusions

To our knowledge, this is the first study to propose medication dose-adjustment recommendations for patients on antidepressants undergoing bariatric surgery. We were limited by the relatively small amount of data available and recommend monitoring patients and use of clinical judgment along with this guidance.

目的我们的目标是回顾有关减肥手术后抗抑郁药血清浓度变化的公开数据,以便为这一患者群体制定用药剂量建议 方法:利用 Pubmed 上的关键搜索关键词进行了全面的文献回顾。从 FDA 和 DrugBank 在线资源中检索了其他数据:结果:除了从 FDA 和 DrugBank 获取的公开数据外,还收录了 12 篇已发表的文章。由于独特的药代动力学特征、药物制备和配方,减肥手术后抗抑郁药的血清浓度在药物类别之间和药物类别内部都存在相当大的差异。根据已公布的血清浓度变化数据和特定药物的药代动力学数据提出了建议:据我们所知,这是第一项针对接受减肥手术的抗抑郁药物患者提出药物剂量调整建议的研究。我们受到可用数据量相对较少的限制,建议对患者进行监测,并在使用本指南的同时使用临床判断。
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引用次数: 0
Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System 要求在 MS-DRG 系统中将谵妄与急性脑病相提并论。
IF 2.3 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.02.004
Mark A. Oldham M.D. , Thomas Heinrich M.D. , James Luccarelli M.D., D.Phil.

Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics.

The authors led a submission to the U.S. Centers for Medicare and Medicaid Services requesting that causally specified delirium be designated major complication or comorbidity alongside toxic and metabolic encephalopathy. Delirium warrants reclassification because it satisfies U.S. Centers for Medicare and Medicaid Services’ guiding principles for re-evaluating Medicare Severity Diagnosis Related Group severity levels. Delirium: (1) has a bidirectional relationship with the permanent condition of dementia (major neurocognitive disorder per DSM-5-TR), (2) indexes vulnerability across populations, (3) impacts healthcare systems across levels of care, (4) complicates postoperative recovery, (5) consigns patients to higher levels of care, (6) impedes patient engagement in care, (7) has several recent treatment guidelines, (8) often indicates neuronal/brain injury, and (9) represents a common expression of terminal illness.

The proposal's impact was explored using the 2019 National Inpatient Sample, which suggested that increasing delirium's complexity designation would lead to an upcoding of less than 1% of eligible discharges. Parity for delirium is essential to enhancing awareness of delirium's clinical and economic costs. Appreciating delirium's impact would encourage delirium prevention and screening efforts, thereby mitigating its dire outcomes for patients, families, and healthcare systems.

自 2007 年以来,医疗保险严重程度诊断相关组分类系统在确定医院报销和几项护理质量价值指标时,更倾向于急性脑病的计费代码,而不是谵妄代码,尽管这两组诊断代码之间存在广泛的重叠。中毒性和代谢性脑病代码被指定为主要并发症或合并症,而因果关系明确的谵妄代码被指定为并发症或合并症,因此报销额度较低,对价值指标的影响也较小。作者牵头向美国医疗保险和医疗补助服务中心提交了一份申请,要求将因果性谵妄与中毒性和代谢性脑病一起列为主要并发症或合并症。谵妄之所以值得重新分类,是因为它符合美国医疗保险和医疗补助服务中心重新评估医疗保险严重程度诊断相关组严重程度的指导原则。谵妄:(1) 与痴呆(DSM-5-TR 规定的主要神经认知障碍)这一永久性疾病有双向关系;(2) 反映不同人群的脆弱性;(3) 影响不同级别的医疗保健系统;(4) 使术后恢复复杂化;(5) 使患者接受更高级别的护理;(6) 阻碍患者参与护理;(7) 有几项最新的治疗指南;(8) 通常表明神经元/脑损伤;(9) 是绝症的常见表现形式。利用 2019 年全国住院病人抽样调查对该提案的影响进行了探讨,结果表明,增加谵妄的复杂性指定将导致符合条件的出院病例中少于 1%的病例被增加编码。谵妄的对等性对于提高人们对谵妄的临床和经济成本的认识至关重要。认识到谵妄的影响将促进谵妄的预防和筛查工作,从而减轻谵妄对患者、家庭和医疗系统造成的严重后果。
{"title":"Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System","authors":"Mark A. Oldham M.D. ,&nbsp;Thomas Heinrich M.D. ,&nbsp;James Luccarelli M.D., D.Phil.","doi":"10.1016/j.jaclp.2024.02.004","DOIUrl":"10.1016/j.jaclp.2024.02.004","url":null,"abstract":"<div><p>Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics.</p><p>The authors led a submission to the U.S. Centers for Medicare and Medicaid Services requesting that causally specified delirium be designated major complication or comorbidity alongside toxic and metabolic encephalopathy. Delirium warrants reclassification because it satisfies U.S. Centers for Medicare and Medicaid Services’ guiding principles for re-evaluating Medicare Severity Diagnosis Related Group severity levels. Delirium: (1) has a bidirectional relationship with the permanent condition of dementia (major neurocognitive disorder per <em>DSM-5-TR</em>), (2) indexes vulnerability across populations, (3) impacts healthcare systems across levels of care, (4) complicates postoperative recovery, (5) consigns patients to higher levels of care, (6) impedes patient engagement in care, (7) has several recent treatment guidelines, (8) often indicates neuronal/brain injury, and (9) represents a common expression of terminal illness.</p><p>The proposal's impact was explored using the 2019 National Inpatient Sample, which suggested that increasing delirium's complexity designation would lead to an upcoding of less than 1% of eligible discharges. Parity for delirium is essential to enhancing awareness of delirium's clinical and economic costs. Appreciating delirium's impact would encourage delirium prevention and screening efforts, thereby mitigating its dire outcomes for patients, families, and healthcare systems.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 302-312"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of the Academy of Consultation-Liaison Psychiatry
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