The Analysis And Strategies On Affecting The Hospital Discharge Willingness By The Psychological Status Of The Medicare Trauma Patients

Objective This article is to explore the psychological status of the Medicare trauma patients, and analyze the factors impact on the discharge willingness, to provide theoretical supports to improve the patient compliance of hospital discharge and reduce the excessive use of health services, so as to reduce the excessive waste of health resources and better improve the universal health care.Method The extensive literature search and detailed perusal is the first step to conduct based on the research topics and content, so as to generally understand and describe the literatures on the mental health of the existing trauma patients and the patients’willingness of hospital discharge through the literature review and data reorganizing. Besides the sorting of concepts and theories, the empirical survey methodology will also be focused on, which is intended to survey and qualitative interview the136trauma patients in The Third Xiangya Hospital of Central South University and Xiangya Boai Rehabilitation Hospital surgical department so as to collect information and data through the use of structured questionnaires and observation. Questionnaire include basic document, self-reporting inventory-90,the self-esteem scale, social anxiety disorder, Eysenck personality questionnaire. After data collection, the researcher will process the data using the statistical methods mainly including the test of reliability and validity, descriptive statistics (frequency, percentages, means and standard deviations) and t-test. In addition, the researcher will also use the multivariate logistic regression technique to analyze the data to survey the related factors of whether the patients are willing to leave the hospital.Result (1) The factor scores and total average of SCL-90for Medicare trauma patients are higher than the general population, and there are significant differences (P<0.05) except for the somatization, interpersonal sensitivity, paranoid and psychotic, the patients’ difference of diverse hospital discharge willingness presents above the level of depression and anxiety (P<0.05). The measured self-esteem level is lower than the national norm but no correlation between the discharge willingness; there is no difference on the social avoidance and anxiety and personality compared to the general population, and with no differences compared to the diverse hospital discharge willingness. On the PTSD symptom distribution of Medicare trauma patients, the probability of blowing to the spirit by the subjective evaluation for trauma is the highest, reaching45.59%, followed by heart palpitations, sweating, chest tightness and discomfort, accounting for43.38%, the lowest distribution is for irritability, reaching13.97%; on avoidance symptom, pessimism and despair occupy the highest proportion, reaching33.09%, the lowest proportion is8.82%to alienate the trust feelings; on alertness increasing, the worry to re-injury by seeing or hearing something related to the trauma occupies the highest proportion, reaching32.35%, the lowest is sleep disorders of8.09%; on impaired social function, the effect on conscious study or work reaches46.32%, the guilty feeling only reaches6.62%. The different hospital discharge willingness has differences on multiple dimensions (P<0.05) such as the total score of PTSD-SS, the subjective evaluation of the traumatic event and repeated reappearing experience.(2) For patients with different hospital discharge willingness, there are significant differences (P<0.05) on their ages, schooling years, health care conditions, type of trauma, hospitalization days and expenses and the treatment effects, but no significant difference (P>0.05) with gender, marital status and work status.(3) There is no statistically significant differences on other scale (P>0.05) except for the levels on SCL-90dimension and PTSD (P<0.05) for the psychological status of injury Medicare and non-injury-Medicare trauma patients; compared to the patients with other types of health insurance, the proportion of Medicare patients is higher, the days and frequency of hospitalization are respectively longer and more and the hospital discharge willingness is lower. Conclusion The degree of the patient’s mental health will affect their willingness of hospital discharge. In order to guarantee the rational application of health services, it is necessary to correct the patients’ abnormal utilization behaviors of inpatient services by a variety of ways such as strengthening the health education and psychological intervention and adjusting the treatment effects.