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Abstract：
Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption.
Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption.
About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (- 6.9% [- 11.7% to - 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (- 6.6% [- 12.7% to - 0.5%]) were less likely to have telepsychiatry.
Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.
Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption.
About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (- 6.9% [- 11.7% to - 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (- 6.6% [- 12.7% to - 0.5%]) were less likely to have telepsychiatry.
Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.
摘要：
获得精神病护理对于从精神病院出院的患者至关重要，以确保护理的连续性。当无法进行面对面随访或不受欢迎时，心灵感应成为一种有希望的选择。本研究旨在调查与采用心灵感应相关的医院和县级特征。3475家急性护理医院的全国横断面数据来自2017年美国医院协会年度调查。使用广义线性回归模型来识别与心灵感应采用相关的特征。
大约六分之一（548[15.8%]）的医院报告有心灵感应，各州差异很大。与农村微型城市（13.6％）和城市县（19.4％）相比，农村非核心医院采用心灵感应的可能性较小（8.3％）。同时提供门诊和住院精神病护理服务的医院（边际差异[95％CI]：16.0％[12.1％至19.9％]）和仅提供门诊精神病服务的医院（6.5％[3.7％至9.4％]）比没有精神病服务的医院更有可能进行心灵感应。联邦医院（48.9%[32.5至65.3%]），系统附属医院(3.9%[1.2%至6.6%])，病床尺寸较大的医院(四分位数IV与I：6.2%[0.7%至11.6%])，以及医疗补助住院天数与总住院天数比例较高的医院(四分位数IV与I：4.9%[0.3%至9.4%])比同行更可能有心灵感应。私人非营利性医院（-6.9％[-11.7％至-2.0％]）和指定为整个精神卫生专业短缺地区的县的医院（-6.6％[-12.7％至-0.5％]）不太可能有心灵感应。
在Covid-19大流行之前，2017年，美国医院的电话心理疗法采用率很低，不同城市和农村状况以及各州的差异很大。这引起了人们对获得精神病服务和出院患者护理连续性的担忧。
大约六分之一（548[15.8%]）的医院报告有心灵感应，各州差异很大。与农村微型城市（13.6％）和城市县（19.4％）相比，农村非核心医院采用心灵感应的可能性较小（8.3％）。同时提供门诊和住院精神病护理服务的医院（边际差异[95％CI]：16.0％[12.1％至19.9％]）和仅提供门诊精神病服务的医院（6.5％[3.7％至9.4％]）比没有精神病服务的医院更有可能进行心灵感应。联邦医院（48.9%[32.5至65.3%]），系统附属医院(3.9%[1.2%至6.6%])，病床尺寸较大的医院(四分位数IV与I：6.2%[0.7%至11.6%])，以及医疗补助住院天数与总住院天数比例较高的医院(四分位数IV与I：4.9%[0.3%至9.4%])比同行更可能有心灵感应。私人非营利性医院（-6.9％[-11.7％至-2.0％]）和指定为整个精神卫生专业短缺地区的县的医院（-6.6％[-12.7％至-0.5％]）不太可能有心灵感应。
在Covid-19大流行之前，2017年，美国医院的电话心理疗法采用率很低，不同城市和农村状况以及各州的差异很大。这引起了人们对获得精神病服务和出院患者护理连续性的担忧。
