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Murray CH, Contreras JL, Kelly CH, Padgett DK, Pollack HA. Behavioral Crisis and First Response: Qualitative Interviews with Chicago Stakeholders. Community Ment Health J 2023; 59:77-84. [PMID: 35751789 PMCID: PMC9243918 DOI: 10.1007/s10597-022-00990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/18/2022] [Indexed: 01/07/2023]
Abstract
Improving interactions between first responders and individuals experiencing behavioral crisis is a critical public health challenge. To gain insight into these interactions, key informant qualitative interviews were conducted with 25 Chicago stakeholders. Stakeholders included directors and staff of community organizations and shelters that frequently engage first responders. Interviews included granular depictions related to the expectations and outcomes of 911 behavioral crisis calls, and noted areas requiring improved response. Stakeholders called 911 an average of 2 to 3 times per month, most often for assistance related to involuntary hospitalization. Engagements with first responders included unnecessary escalation or coercive tactics, or conversely, refusal of service. While stakeholders lauded the value of police trained through the city's Crisis Intervention Team program, they emphasized the need for additional response strategies that reduce the role of armed police, and underscored the need for broader social and behavioral health services for individuals at-risk of such crises.
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Affiliation(s)
- Conor H. Murray
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
- Urban Health Lab, University of Chicago, Chicago, USA
| | - Juan L. Contreras
- Urban Health Lab, University of Chicago, Chicago, USA
- Crown Family School of Social Work Policy and Practice, University of Chicago, 969 E 60th St, Chicago, IL 60637 USA
| | - Caroline H. Kelly
- Urban Health Lab, University of Chicago, Chicago, USA
- Crown Family School of Social Work Policy and Practice, University of Chicago, 969 E 60th St, Chicago, IL 60637 USA
| | - Deborah K. Padgett
- Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003 USA
| | - Harold A. Pollack
- Urban Health Lab, University of Chicago, Chicago, USA
- Crown Family School of Social Work Policy and Practice, University of Chicago, 969 E 60th St, Chicago, IL 60637 USA
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
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Factors associated with 30-days and 180-days psychiatric readmissions: A snapshot of a metropolitan area. Psychiatry Res 2020; 292:113309. [PMID: 32702551 DOI: 10.1016/j.psychres.2020.113309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023]
Abstract
Psychiatric re-hospitalization rate is a widely used quality indicator within mental health care. This study aims to investigate which variables are implied in determining readmissions over two intervals after the index event, 30 days and 6 months. The study sample included 798 inpatients, it was divided into two groups: not readmitted patients (NRP) and readmitted patients (RP), which has been further split into: Readmitted within 30 days (RP30dd) and Readmitted during the 150-day period (between 31 and 180 days) after the index discharge (RP150). A multivariate logistic regression with backward selection method was performed in order to find variables independently associated with readmission. The overall incidence of readmissions was 16.04%. Discharge to a Psychiatric Nursing Home was found to be a protective factor for all the groups. In adds, for the overall readmission, compulsory index admission and higher education (this lasts as in RP30dd group) were protective factors; whereas higher length of stay (as for readmission within 31-180 days) and a diagnosis of Personality Disorder were risk factors. The patient-specific factors significantly associated with likelihood of rehospitalization in the final model do identify some high-risk groups toward to whom possibly address prevention strategies.
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Musy SN, Endrich O, Leichtle AB, Griffiths P, Nakas CT, Simon M. Longitudinal Study of the Variation in Patient Turnover and Patient-to-Nurse Ratio: Descriptive Analysis of a Swiss University Hospital. J Med Internet Res 2020; 22:e15554. [PMID: 32238331 PMCID: PMC7163415 DOI: 10.2196/15554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 02/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background Variations in patient demand increase the challenge of balancing high-quality nursing skill mixes against budgetary constraints. Developing staffing guidelines that allow high-quality care at minimal cost requires first exploring the dynamic changes in nursing workload over the course of a day. Objective Accordingly, this longitudinal study analyzed nursing care supply and demand in 30-minute increments over a period of 3 years. We assessed 5 care factors: patient count (care demand), nurse count (care supply), the patient-to-nurse ratio for each nurse group, extreme supply-demand mismatches, and patient turnover (ie, number of admissions, discharges, and transfers). Methods Our retrospective analysis of data from the Inselspital University Hospital Bern, Switzerland included all inpatients and nurses working in their units from January 1, 2015 to December 31, 2017. Two data sources were used. The nurse staffing system (tacs) provided information about nurses and all the care they provided to patients, their working time, and admission, discharge, and transfer dates and times. The medical discharge data included patient demographics, further admission and discharge details, and diagnoses. Based on several identifiers, these two data sources were linked. Results Our final dataset included more than 58 million data points for 128,484 patients and 4633 nurses across 70 units. Compared with patient turnover, fluctuations in the number of nurses were less pronounced. The differences mainly coincided with shifts (night, morning, evening). While the percentage of shifts with extreme staffing fluctuations ranged from fewer than 3% (mornings) to 30% (evenings and nights), the percentage within “normal” ranges ranged from fewer than 50% to more than 80%. Patient turnover occurred throughout the measurement period but was lowest at night. Conclusions Based on measurements of patient-to-nurse ratio and patient turnover at 30-minute intervals, our findings indicate that the patient count, which varies considerably throughout the day, is the key driver of changes in the patient-to-nurse ratio. This demand-side variability challenges the supply-side mandate to provide safe and reliable care. Detecting and describing patterns in variability such as these are key to appropriate staffing planning. This descriptive analysis was a first step towards identifying time-related variables to be considered for a predictive nurse staffing model.
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Affiliation(s)
- Sarah N Musy
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Nursing and Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olga Endrich
- Medical Directorate, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Insel Data Science Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander B Leichtle
- Insel Data Science Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Griffiths
- Health Sciences, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research Applied Research Collaboration (Wessex), Southampton, United Kingdom.,LIME Karolinska Institutet, Stockholm, Sweden
| | - Christos T Nakas
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Laboratory of Biometry, University of Thessaly, Volos, Greece
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Nursing and Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Michel M, Alberti C, Carel JC, Chevreul K. Socioeconomic Status of Newborns and Hospital Efficiency: Implications for Hospital Payment Methods. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:335-342. [PMID: 32197729 DOI: 10.1016/j.jval.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Studies have shown a consistent impact of socioeconomic status at birth for both mother and child; however, no study has looked at its impact on hospital efficiency and financial balance at birth, which could be major if newborns from disadvantaged families have an average length of stay (LOS) longer than other newborns. Our objective was therefore to study the association between socioeconomic status and hospital efficiency and financial balance in that population. METHODS A study was carried out using exhaustive national hospital discharge databases. All live births in a maternity hospital located in mainland France between 2012 and 2014 were included. Socioeconomic status was estimated with an ecological indicator and efficiency by variations in patient LOS compared with different mean national LOS. Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level by the difference in aggregated revenues and production costs for said hospital. Multivariate regression models studied the association between those indicators and socioeconomic status. RESULTS A total of 2 149 454 births were included. LOS was shorter than the national means for less disadvantaged patients and longer for the more disadvantaged patients, which increased when adjusted for gestational age, birth weight, and severity. A 1% increase in disadvantaged patients in a hospital's case mix significantly increased the probability that the hospital would be in deficit by 2.6%. CONCLUSIONS Reforms should be made to hospital payment methods to take into account patient socioeconomic status so as to improve resource allocation efficiency.
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Affiliation(s)
- Morgane Michel
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France.
| | - Corinne Alberti
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France; French National Institute of Health and Medical Research, Clinical Investigation Centers, CIC, Paris, France
| | - Jean-Claude Carel
- AP-HP, Hôpital Robert Debré, Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France; INSERM, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France
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Tedeschi F, Donisi V, Salazzari D, Cresswell-Smith J, Wahlbeck K, Amaddeo F. Clinical and organizational factors predicting readmission for mental health patients across Italy. Soc Psychiatry Psychiatr Epidemiol 2020; 55:187-196. [PMID: 31463615 DOI: 10.1007/s00127-019-01766-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors. METHODS The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single- and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates. RESULTS The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree. CONCLUSIONS Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.
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Affiliation(s)
- Federico Tedeschi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy.
| | - V Donisi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - D Salazzari
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - J Cresswell-Smith
- Mental Health Unit, National Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - K Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - F Amaddeo
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
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Michaud L, Stiefel F, Moreau D, Dorogi Y, Morier-Genoud A, Bourquin C. Suicides in Psychiatric Patients: Identifying Health Care-Related Factors through Clinical Practice Reviews. Arch Suicide Res 2020; 24:S150-S164. [PMID: 30856364 DOI: 10.1080/13811118.2019.1586606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The objective of this study was to identify health care-related factors associated with death by suicide in psychiatric patients and to gain insight into clinician views on how to deal with suicidality. The study material derived from a clinician committee in a psychiatric department reviewing every outpatient and inpatient suicide in a standardized way. Reports' conclusions and corresponding plenary discussion minutes regarding 94 suicides were analyzed using inductive thematic content analysis. Health care-related factors were categorized into 4 themes: patient evaluation, patient management, clinician training, and involvement of relevant non-clinical partners. Clinician views on the themes were expressed through statements (i) promoting or restricting an aspect of care (here called recommendations), which mainly followed existing guidelines and were consensual and (ii) without precise indication (here called comments), which departed from mainstream opinions or addressed topics not covered by existing policy. Involvement of non-clinical partners emerged as a new key issue for suicide prevention in psychiatric departments and should be openly discussed with patients. Clinicians preferred balanced conclusions when they reviewed suicide cases.
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Affiliation(s)
- Laurent Michaud
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Pavilion Frank B. Common, Montreal (Québec), Canada.,Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Delphine Moreau
- School of Health Science of Vaud (HESAV), University of Applied sciences and Art of Western Switzerland, Lausanne, Switzerland
| | - Yves Dorogi
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Anouk Morier-Genoud
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
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Michel M, Alberti C, Carel JC, Chevreul K. Association of Pediatric Inpatient Socioeconomic Status With Hospital Efficiency and Financial Balance. JAMA Netw Open 2019; 2:e1913656. [PMID: 31626320 PMCID: PMC6813670 DOI: 10.1001/jamanetworkopen.2019.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE In health care systems in which hospital reimbursement is based on a national mean length of stay (LOS), disadvantaged patients with an increased LOS may be a source of inefficiency. This implication has been reported in adult patients, but pediatric data have been scarce. OBJECTIVE To examine the association of patient socioeconomic status with hospital efficiency and financial balance in pediatrics. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from the French national hospital discharge database covering a 3-year period, from January 1, 2012, to December 31, 2014. Statistical analyses were performed between June 2016 and December 2018. All inpatient stays in hospital pediatric wards in mainland France by children older than 28 days or younger than 18 years (n = 4 121 187) were included. Admissions with coding errors or missing values for social disadvantage and/or cost calculations were excluded. EXPOSURE Social disadvantage was estimated with an ecological indicator, the FDep, available at the patient's postcode of residence and divided into national quintiles. MAIN OUTCOMES AND MEASURES Efficiency was assessed through the variations in patient LOS compared with different national mean LOS (for pediatric patients, pediatric patients with a similar condition, and pediatric patients with a similar condition and severity level). Hospital financial balance was assessed at the admission level through the ratio of production costs to revenues and at the hospital level through the difference between aggregated revenues and production costs. Multivariate regression models examined the association between these indicators and socioeconomic status. RESULTS A total of 4 121 187 admissions were included (2 336 540 [56.7%] male; mean [SD] age, 7.4 [5.8] years). In all, 1 561 219 patients (37.9%) were in the 2 most disadvantaged quintiles. Patient LOS was shorter than the national mean LOS (mean [SD], 1.73 [4.21] days) for patients in the least disadvantaged quintile and longer for those in the more disadvantaged quintile (mean [SD], 1.67 [4.33] days vs 1.82 [4.14] days). This difference was higher for diagnosis related groups that included both adult and pediatric patients (mean [SD], 1.46 [4.22] days vs 1.61 [4.13] days) compared with those dedicated to pediatric patients (2.22 [4.13] days vs 2.12 [4.53] days). Patients in the most disadvantaged quintile were associated with a 3.2% increase in LOS (odds ratio, 1.0322; 95% CI, 1.0302-1.0341) compared with the national mean LOS. Social disadvantage was also associated with a significant increase in financial deficit for hospitals with 20% to 60% of patients in the 2 most disadvantaged quintiles (estimate: -€146 389; 95% CI, -€279 566 to -€13 213). CONCLUSIONS AND RELEVANCE Patient socioeconomic status appears to be statistically significantly associated with an increase in LOS and cost in French hospitals with pediatric departments. This finding suggests that initiating reform in hospital payment methods may improve resource allocation efficiency and equity in access to pediatric care.
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Affiliation(s)
- Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
| | - Corinne Alberti
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
- Inserm, Centre d'Investigation Clinique (CIC) 1426, Paris, France
| | - Jean-Claude Carel
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Department of Pediatric Endocrinology and Diabetology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Inserm, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
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Abstract
The risk of suicide is higher during the period immediately following discharge from in-patient psychiatric care than at any other time in a service user's life. Demographic and clinical risk factors for suicide in this period are similar to those for suicide at other times and may not be specific enough to enable identification of those at greatest risk. Epidemiological studies suggest that factors related to service organisation and delivery (e.g. social support and continuity of care) are also important in the aetiology of suicide following hospital discharge. Interventions aimed at helping people in the period immediately following discharge from in-patient care have been developed. Although the effect of these interventions on suicidal behaviour has not been examined, available evidence suggests that efforts to increase patients' confidence and level of social support may be of value.
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Abstract
Patient turnover influences the quality and safety of patient care. However, variations in the conceptual underpinnings of patient turnover limit the understanding of the phenomenon. A concept analysis was completed to clarify the role of patient turnover in relation to outcomes in the acute care hospital setting. The defining attributes, antecedents, consequences, and empirical referents of patient turnover were proposed. Nursing leaders should account for patient turnover in workload and staffing calculations. Further research is needed to clarify the influence of patient turnover on the quality and safety of nursing care using a unified understanding of the phenomenon.
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Abstract
OBJECTIVE Readmission rates have been proposed as a possible quality metric for inpatient psychiatry. Little is known about predicting readmissions and identifying modifiable factors that may reduce early readmissions in these settings. METHODS We reviewed 693 medical records from our adult inpatient psychiatric unit to identify factors associated with patients' readmission within 90 days of discharge. RESULTS After adjusting for all variables, and including interactions between identified factors, we found several demographic features predicting readmission, including male gender with suicidal ideation on admission (odds ratio [OR] = 13.2; 95% confidence interval [CI], 3.4-51.9), a diagnosis of a psychotic disorder with a prior medical admission (OR = 5.7; 95% CI, 1.7-20.6), and suicidal ideation with comorbid personality disorder (OR = 5.3; 95% CI, 1.4-20.6). Demographic features decreasing the odds of readmission included being non-white with homeless living situation (OR = 0.18; 95% CI, 0.04-0.82), medication changes made within 48 hours of discharge (OR = 0.44; 95% CI, 0.23-0.84), and the number of medications dispensed without documented follow-up plan or appointment (OR = 0.88; 95% CI, 0.81-0.96). CONCLUSION Future prospective studies utilizing qualitative and quantitative methods are required to more precisely define a wider array of metrics. Improved identification of demographic features associated with early readmissions may suggest areas to target as we seek to the quality of inpatient psychiatric care.
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Taylor C, Holsinger B, Flanagan JV, Ayers AM, Hutchison SL, Terhorst L. Effectiveness of a Brief Care Management Intervention for Reducing Psychiatric Hospitalization Readmissions. J Behav Health Serv Res 2017; 43:262-71. [PMID: 24627234 DOI: 10.1007/s11414-014-9400-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examines a recovery-focused care management bridging strategy implemented during time of inpatient stay with the goal to increase engagement in aftercare and reduce early psychiatric readmissions. The sample included 195 individuals who received care from a large psychiatric specialty hospital. Eighty-seven individuals were assigned to receive the intervention, while 108 individuals were assigned to the control group. Individuals in the intervention group received a brief interview prior to inpatient discharge plus usual care, and individuals in the control group received usual care. After controlling for age, living situation, and utilization, individuals in the control group were more likely to be readmitted within 30 days of an index readmission than individuals in the intervention group (OR = 2.44, p = .02). Bridging strategies utilized prior to discharge for individuals at higher risk of early mental health inpatient readmission may be used as an effective alternative to more costly interventions.
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Affiliation(s)
- Carole Taylor
- Community Care Behavioral Health Organization, One Chatham Center, Suite 700, 112 Washington Place, Pittsburgh, PA, 15219, USA.
| | - Brandi Holsinger
- Community Care Behavioral Health Organization, One Chatham Center, Suite 700, 112 Washington Place, Pittsburgh, PA, 15219, USA
| | - Jenny V Flanagan
- Community Care Behavioral Health Organization, One Chatham Center, Suite 700, 112 Washington Place, Pittsburgh, PA, 15219, USA
| | - Amanda M Ayers
- Community Care Behavioral Health Organization, One Chatham Center, Suite 700, 112 Washington Place, Pittsburgh, PA, 15219, USA
| | - Shari L Hutchison
- Community Care Behavioral Health Organization, One Chatham Center, Suite 700, 112 Washington Place, Pittsburgh, PA, 15219, USA
| | - Lauren Terhorst
- Community Care Behavioral Health Organization, One Chatham Center, Suite 700, 112 Washington Place, Pittsburgh, PA, 15219, USA
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Kalseth J, Lassemo E, Wahlbeck K, Haaramo P, Magnussen J. Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature. BMC Psychiatry 2016; 16:376. [PMID: 27821155 PMCID: PMC5100223 DOI: 10.1186/s12888-016-1099-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/30/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Psychiatric readmissions have been studied at length. However, knowledge about how environmental and health system characteristics affect readmission rates is scarce. This paper systemically reviews and discusses the impact of health and social systems as well as environmental characteristics for readmission after discharge from inpatient care for patients with a psychiatric diagnosis. METHODS Comprehensive literature searches were conducted in the electronic bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. In addition, Google Scholar was utilised. Relevant publications published between January 1990 and June 2014 were included. No restrictions regarding language or publication status were imposed. A qualitative synthesis of the included studies was performed. Variables describing system and environmental characteristics were grouped into three groups: those capturing regulation, financing system and governance; those capturing capacity, organisation and structure; and those capturing environmental variables. RESULTS Of the 734 unique articles identified in the original search, 35 were included in the study. There is a limited number of studies on psychiatric readmissions and their association with environmental and health system characteristics. Even though the review reveals an extensive list of characteristics studied, most characteristics appear in a very limited number of articles. The most frequently studied characteristics are related to location (local area, district/region/country). In most cases area differences were found, providing strong indication that the risk of readmission not only relates to patient characteristics but also to system and/or environmental factors that vary between areas. The literature also points in the direction of a negative association of institutional length of stay and community aftercare with readmission for psychiatric patients. CONCLUSION This review shows that analyses of system level variables are scarce. Furthermore they differ with respect to purpose, choice of system characteristics and the way these characteristics are measured. The lack of studies looking at the relationship between readmissions and provider payment models is striking. Without the link to provider payment models and other health system characteristics related to regulation, financing system and governance structure it becomes more difficult to draw policy implications from these analyses.
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Affiliation(s)
- Jorid Kalseth
- SINTEF Technology and Society, Health Research, P.O. Box 4760 Sluppen, NO-7465, Trondheim, Norway.
| | - Eva Lassemo
- SINTEF Technology and Society, Health Research, P.O. Box 4760 Sluppen, NO-7465 Trondheim, Norway
| | - Kristian Wahlbeck
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Peija Haaramo
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Jon Magnussen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Faculty of Medicine, P.O. Box 8905, MTFS, NO-7491 Trondheim, Norway
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Hamilton JE, Passos IC, de Azevedo Cardoso T, Jansen K, Allen M, Begley CE, Soares JC, Kapczinski F. Predictors of psychiatric readmission among patients with bipolar disorder at an academic safety-net hospital. Aust N Z J Psychiatry 2016; 50:584-93. [PMID: 26377747 DOI: 10.1177/0004867415605171] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Even with treatment, approximately one-third of patients with bipolar disorder relapse into depression or mania within 1 year. Unfavorable clinical outcomes for patients with bipolar disorder include increased rates of psychiatric hospitalization and functional impairment. However, only a few studies have examined predictors of psychiatric hospital readmission in a sample of patients with bipolar disorder. The purpose of this study was to examine predictors of psychiatric readmission within 30 days, 90 days and 1 year of discharge among patients with bipolar disorder using a conceptual model adapted from Andersen's Behavioral Model of Health Service Use. METHODS In this retrospective study, univariate and multivariate logistic regression analyses were conducted in a sample of 2443 adult patients with bipolar disorder who were consecutively admitted to a public psychiatric hospital in the United States from 1 January to 31 December 2013. RESULTS In the multivariate models, several enabling and need factors were significantly associated with an increased risk of readmission across all time periods examined, including being uninsured, having ⩾3 psychiatric hospitalizations and having a lower Global Assessment of Functioning score. Additional factors associated with psychiatric readmission within 30 and 90 days of discharge included patient homelessness. Patient race/ethnicity, bipolar disorder type or a current manic episode did not significantly predict readmission across all time periods examined; however, patients who were male were more likely to readmit within 1 year. The 30-day and 1-year multivariate models showed the best model fit. CONCLUSION Our study found enabling and need factors to be the strongest predictors of psychiatric readmission, suggesting that the prevention of psychiatric readmission for patients with bipolar disorder at safety-net hospitals may be best achieved by developing and implementing innovative transitional care initiatives that address the issues of multiple psychiatric hospitalizations, housing instability, insurance coverage and functional impairment.
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Affiliation(s)
- Jane E Hamilton
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Ives C Passos
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Taiane de Azevedo Cardoso
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Karen Jansen
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Melissa Allen
- UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Charles E Begley
- Center for Health Services Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Flavio Kapczinski
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
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Han KT, Lee SY, Kim SJ, Hahm MI, Jang SI, Kim SJ, Kim W, Park EC. Readmission rates of South Korean psychiatric inpatients by inpatient volumes per psychiatrist. BMC Psychiatry 2016; 16:96. [PMID: 27059818 PMCID: PMC4826507 DOI: 10.1186/s12888-016-0804-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Readmission rates of psychiatric inpatients are higher in South Korea than other Organization for Economic Co-operation and Development (OECD) countries. In addition, the solution for readmission control is deficient based on the characteristics of the South Korean National Health Insurance (NHI) system. Therefore, it is necessary to identify ways to reduce psychiatric inpatient readmissions. This study investigated the relationship between inpatient volume per psychiatrist and the readmission rate of psychiatric inpatients in South Korea. METHOD We used NHI claim data (N = 37,796) from 53 hospitals to analyze readmission within 30 days for five diagnosis (organic mental disorders, mental and behavioral disorders due to psychoactive substance use, schizophrenia, mood disorders, neurotic disorders, and stress-related and somatoform disorders) between 2010 and 2013. We performed χ2 and analysis of variance tests to investigate associations between patient and hospital-level variables and readmission within 30 days. Finally, generalized estimating equation (GEE) models were analyzed to examine possible associations with readmission. RESULTS Readmissions within 30 days accounted for 1,598 (4.5 %) claims. Multilevel analysis demonstrated that inpatient volume per psychiatrist were inversely related with readmission within 30 days (low odds ratio [OR]: 0.38, 95 % confidence interval [CI]: 0.28-0.51; mid-low OR: 0.48, 95 % CI: 0.36-0.63; mid-high OR: 0.55, 95 % CI: 0.44-0.69; Q4 = ref). The subgroup analysis by diagnosis revealed that both "schizophrenia, schizotypal, and delusional disorders" and "mood disorders" had inverse relationships with readmission risk for all volume groups. CONCLUSIONS We observed an inverse association between inpatient volume per psychiatrist and the 30-day readmission rate of psychiatric inpatients, suggesting that it could be a useful quality indicator in mental health care.
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Affiliation(s)
- Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Yoon Lee
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea ,Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration and Management, Soonchunhyang University, Asan, Republic of Korea
| | - Myung-Il Hahm
- Department of Health Administration and Management, Soonchunhyang University, Asan, Republic of Korea
| | - Sung-In Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea ,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 Republic of Korea
| | - Seung Ju Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woorim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Abstract
BACKGROUND Aims of this study are to explore the associations of readmission to psychiatric hospital over time, to develop a statistical model for early readmission to psychiatric hospital and to assess the feasibility of predicting early readmission. METHOD The sample comprised 7891 general psychiatric discharges in South London, taken from a large anonymised repository of electronic patient records. We initially explored time to readmission using Cox regression - this included investigation of time-dependent effects. Subsequently, we used logistic regression to create a predictive model for 90-day readmission. We investigated the effect on readmission of a set of variables that included demographic variables, diagnosis and legal status during the index admission, previous service use, housing variables and individual item scores on the Health of the Nation Outcome Scales (HoNOS) at admission and at discharge. RESULTS Fifteen per cent of those discharged were readmitted within 90 days. Cox regression demonstrated that the estimated baseline hazard of readmission declined steeply after discharge and that the effects of several predictors, especially diagnosis, changed over time - most notably, personality disorder was associated with increased readmission relative to schizophrenia at the time of discharge, but did not significantly differ by 1-year postdischarge. In the logistic regression, increased readmission was associated with personality disorder diagnosis; shorter length of the index admission (excepting zero length admissions); number of discharges in the preceding 2 years; and having a high score at discharge on the HoNOS overactive and aggressive behaviour item, cognitive problems item or hallucinations and delusions items. Detention under Section 3 or a forensic section of the Mental Health Act during the index admission was associated with reduced readmission. The coefficient of discrimination for the logistic regression, which is equivalent to r 2, was 0.04 and the estimated area under the receiver operating curve was 0.65. CONCLUSIONS The association found between early readmission and personality disorder diagnosis merits further investigation, as does the possible trade-off between reduction in length of stay and increased readmission. Other novel findings such as the associations found with HoNOS item scores also merit replication. As with previous studies, we found that the rate of readmission declines steeply after hospital discharge, so that the period immediately subsequent to discharge is a period of comparatively high risk. However, prediction of early readmission within this high-risk group remains challenging - it seems most likely that many unmeasured influences operate subsequent to the time of discharge.
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Bonsack C, Golay P, Gibellini Manetti S, Gebel S, Ferrari P, Besse C, Favrod J, Morandi S. Linking Primary and Secondary Care after Psychiatric Hospitalization: Comparison between Transitional Case Management Setting and Routine Care for Common Mental Disorders. Front Psychiatry 2016; 7:96. [PMID: 27313547 PMCID: PMC4889580 DOI: 10.3389/fpsyt.2016.00096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To improve engagement with care and prevent psychiatric readmission, a transitional case management intervention has been established to link with primary and secondary care. The intervention begins during hospitalization and ends 1 month after discharge. The goal of this study was to assess the effectiveness of this short intervention in terms of the level of engagement with outpatient care and the rate of readmissions during 1 year after discharge. METHODS Individuals hospitalized with common mental disorders were randomly assigned to be discharged to routine follow-up by private psychiatrists or general practitioners with (n = 51) or without (n = 51) the addition of a transitional case management intervention. Main outcome measures were number of contacts with outpatient care and rate of readmission during 12 months after discharge. RESULTS Transitional case management patients reported more contacts with care service in the period between 1 and 3 months after discharge (p = 0.004). Later after discharge (3-12 months), no significant differences of number of contacts remained. The transitional case management intervention had no statistically significant beneficial impact on the rate of readmission (hazard ratio = 0.585, p = 0.114). CONCLUSION The focus on follow-up after discharge during hospitalization leads to an increased short-term rate of engagement with ambulatory care despite no differences between the two groups after 3 months of follow-up. This short transitional intervention did, however, not significantly reduce the rate of readmissions during the first year following discharge. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier NCT02258737.
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Affiliation(s)
- Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV) , Lausanne , Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV) , Lausanne , Switzerland
| | - Silvia Gibellini Manetti
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV) , Lausanne , Switzerland
| | - Sophia Gebel
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV) , Lausanne , Switzerland
| | - Pascale Ferrari
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV), Lausanne, Switzerland; La Source School of Nursing Sciences (HEdS La Source), University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Christine Besse
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV) , Lausanne , Switzerland
| | - Jérome Favrod
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV), Lausanne, Switzerland; La Source School of Nursing Sciences (HEdS La Source), University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Consultations de Chauderon, Lausanne University Hospital (CHUV) , Lausanne , Switzerland
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Park SH, Weaver L, Mejia-Johnson L, Vukas R, Zimmerman J. An Integrative Literature Review of Patient Turnover in Inpatient Hospital Settings. West J Nurs Res 2015; 38:629-55. [DOI: 10.1177/0193945915616811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High patient turnover can result in fragmentation of nursing care. It can also increase nursing workload and thus impede the ability of nurses to provide safe and high-quality care. We reviewed 20 studies that examined patient turnover in relation to nursing workload, staffing, and patient outcomes as well as interventions in inpatient hospital settings. The studies consistently addressed the importance of accounting for patient turnover when estimating nurse staffing needs. They also showed that patient turnover varied by time, day, and unit type. Researchers found that higher patient turnover was associated with adverse events; however, further research on this topic is needed because evidence on the effect of patient turnover on patient outcomes is not yet strong and conclusive. We suggest that researchers and administrators need to pay more attention to patterns and levels of patient turnover and implement managerial strategies to reduce nursing workload and improve patient outcomes.
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Affiliation(s)
- Shin Hye Park
- University of Kansas Medical Center, Kansas City, USA
| | | | | | - Rachel Vukas
- University of Kansas Medical Center, Kansas City, USA
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Sunderji N, de Bibiana JT, Stergiopoulos V. Urgent Psychiatric Services: A Scoping Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:393-402. [PMID: 26454727 PMCID: PMC4574715 DOI: 10.1177/070674371506000904] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Urgent psychiatric services can provide timely access to ambulatory psychiatric assessment and short-term treatment for patients experiencing a mental health crisis or risk of rapid deterioration requiring hospitalization, yet little is known about how best to organize mental health service delivery for this population. Our scoping review was conducted to identify knowledge gaps and inform program development and quality improvement. METHOD We searched MEDLINE, PsycINFO, CINAHL, Embase, and EBM Reviews for English-language articles, published from January 1993 to June 2014, using relevant key words and subject headings. Reverse and forward citations were manually searched using reference lists and Google Scholar. Articles were included if they described programs providing ambulatory psychiatric assessment (with or without treatment) within 2 weeks of referral. RESULTS We identified 10 programs providing urgent psychiatric services. Programs targeted a diagnostically heterogeneous population with acute risks and intensive needs. Most programs included a structured process for triage, strategies to improve accessibility and attendance, interprofessional staffing, short-term treatment, and efforts to improve continuity of care. Despite substantial methodological limitations, studies reported improvements in symptom severity, distress, psychosocial functioning, mental health-related quality of life, subjective well-being, and satisfaction with care, as well as decreased wait times for post-emergency department (ED) ambulatory care, and averted ED visits and admissions. CONCLUSIONS Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies.
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Affiliation(s)
- Nadiya Sunderji
- Staff Psychiatrist and Medical Director, Ambulatory Care, St Michael's Hospital, Toronto, Ontario; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Vicky Stergiopoulos
- Clinician Scientist, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario; Psychiatrist-in-Chief, St Michael's Hospital, Toronto, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
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Abstract
The current study examined the association between number of hours attended of the Illness Management and Recovery (IMR) program and psychiatric readmission rates after discharge from a state psychiatric hospital. The study used archival data, N = 1186, from a large northeastern state psychiatric hospital in the United States. A Cox's regression survival analyses was conducted, adjusting for extreme outliers and controlling for sociodemographic covariates, to examine the association between different amounts of IMR and the risk for returning to the hospital. After controlling for the client characteristics of age, sex, marital status, psychiatric diagnosis, and Global Assessment of Functioning score at discharge, as well as controlling for mean daily dose of generic hospital programming and the number of days of hospitalization, it was found that, for each hour of IMR, there was an associated 1.1% reduction in the risk for returning to the hospital. This suggests that participation in IMR while in inpatient settings may assist individuals in reducing their risk for returning to the hospital.
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20
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Moss J, Li A, Tobin J, Weinstein IS, Harimoto T, Lanctôt KL. Predictors of readmission to a psychiatry inpatient unit. Compr Psychiatry 2014; 55:426-30. [PMID: 24405773 DOI: 10.1016/j.comppsych.2013.11.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/28/2013] [Accepted: 11/26/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine predictors of time to readmission to a general psychiatry inpatient unit. METHOD Data from the Minimum Data Set-Mental Health (MDS-MH), a standardized assessment used to collect demographic and clinical information, were retrospectively reviewed from April 2006 through October 2008. A total of 758 patients were eligible for the study. A set of clinically relevant predictors was generated based on a literature review. A Cox regression model was applied to determine which variables were most predictive of shorter time to readmission, and their respective hazard ratios (HR). RESULTS Covariates that were significantly associated with readmission (HR [95% CI]) included receiving a pass (3.48 [2.33, 5.17], p ≤ 0.0005), 1-2 psychiatric admissions in the past two years (15.63 [7.50, 32.55], p ≤ 0.0005), and more than 3 psychiatric admissions in the past two years (24.15 [11.58, 50.36], p ≤ 0.0005). Post hoc analysis indicated that those issued passes were more commonly male (57.1% vs. 43.9%, p=0.03), with a longer length of stay (25.4 ± 21.2 days vs. 18.7 ± 21.1 days, p=0.008), and higher GAF score (62.8 ± 11.1 vs. 57.8 ± 13.9, p=0.003), but were otherwise similar. CONCLUSIONS The factors that were associated with reduced time to readmission were a history of previous admissions and receipt of a pass prior to discharge. These results suggest that while physicians may be able to identify patients at high risk of early readmission, issuing a pass may not fully mitigate this risk. There is a need for critical research evaluating the potential benefits of passes.
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Affiliation(s)
- Jay Moss
- Department of Psychiatry, Faculty of Medicine, University of Toronto.
| | - Abby Li
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Tobin
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Izak S Weinstein
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tetsuhiro Harimoto
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Faculty of Medicine, University of Toronto; Department of Pharmacology/Toxicology, Faculty of Medicine, University of Toronto; Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Tharayil PR, Sigrid J, Morgan R, Freeman K. Examining Outcomes of Acute Psychiatric Hospitalization among Children. SOCIAL WORK IN MENTAL HEALTH 2012; 10:205-232. [PMID: 23946699 PMCID: PMC3740792 DOI: 10.1080/15332985.2011.628602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Within the past two decades, few studies have examined outcomes of acute psychiatric hospitalization among children, demonstrating change in emotional and behavioral functioning. A secondary analysis of pre-test/post-test data collected on 36 children was conducted, using the Target Symptom Rating (TSR). The TSR is a 13-item measure with two subscales - Emotional Problems and Behavioral Problems and was designed for evaluation of outcome among children and adolescents in acute inpatient psychiatric settings. Results of this study, its limitations, and the barriers encountered in the implementation of the TSR scale as part of routine clinical practice are discussed.
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Heggestad T, Lilleeng SE, Ruud T. Patterns of mental health care utilisation: distribution of services and its predictability from routine data. Soc Psychiatry Psychiatr Epidemiol 2011; 46:1275-82. [PMID: 20938639 DOI: 10.1007/s00127-010-0295-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 09/22/2010] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Explore if a multi-dimensional analytic approach to routinely registered data provides a comprehensive way to characterise utilisation patterns, and to test if the patients' functional status is a predictor for the use of services. METHOD We linked register contact data during a two-year period, including all types of specialised mental health services, in the population of a Norwegian county. Cox regression was applied in the models for prediction of admission and readmission. RESULTS Great variability and complexity in patterns of utilisation were found, including multiple transitions between in-patient and out-patient statuses. The distribution of services was characterised by a small group of patients receiving a disproportionally large amount of resources. A majority of 77% appeared as out-patients only. Severity of symptoms as well as of dysfunction, as assessed by the split GAF-score, differentiated amongst utilisation groups. Both dimensions were significant predictors for admission. In contrast, only the severity of dysfunction predicted readmission. CONCLUSION Multi-dimensional data architecture and analytical perspectives can be applied to routine data, and should be used to analyse the diverse patterns of utilisation. Risk populations could be predicted by routinely registered information on functional status.
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Affiliation(s)
- Torhild Heggestad
- Performance Data Unit, Department of Research and Development, Haukeland University Hospital, 5021 Bergen, Norway.
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Gbiri CA, Badru FA, Ladapo HTO, Gbiri AA. Socio-economic correlates of relapsed patients admitted in a Nigerian mental health institution. Int J Psychiatry Clin Pract 2011; 15:19-26. [PMID: 22122685 DOI: 10.3109/13651501.2010.506954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Relapse in psychiatric disorders is highly distressing, costly and engenders burn-out syndrome among mental-health workers. AIMS To study the socio-economic factors associated with relapse in individual admitted with psychiatric disorders and the pattern of socio-economic impact of relapse in those groups. METHODS A cross-sectional survey of all relapsed patients without cognitive deficit admitted into the federal Neuro-Psychiatric Hospital, Lagos, Nigeria between June and October 2007 was conducted using a self-validated Structured Interview Schedule (Relapse Socio-economic Impact Interview Schedule) and Key Informant Interview Guide. Secondary data were elicited from the patient folders, case notes, ward admission registers and nominal rolls. Data were summarised using mean, standard deviation, frequency and percentiles. Pearson's moment correlation coefficient was used to test the association among variables. The Mann-Whitney U-test was used to compare the pre-morbid and the post-morbid states. RESULTS This study involved 102 respondents. Their mean age was 36.5 ± 9.8 years, mainly of male gender (72.5%) suffering from schizophrenic disorder (37.8%). Relapse and re-admission ranged between 2 and 12. Unemployment rate, marital separation and divorce increased more than 5-fold from pre-morbid to morbid states. Few (4.9%) could still settle their hospital/drug bills on their own, while most (95.1%) depended on family, philanthropist and government/waivers to pay for their bills. Their social relationships were negatively influenced with most of them expressing social isolation and low quality of life. There were significant relationships (P<0.05) between age, sex, number of relapses, number of admissions, pre-morbid marital status, morbid state marital status, pre-morbid state occupational status and morbid state occupational status. There was significant change (P= 0.00) in the quality of life, societal integration/acceptability, economic status, employment status and marital status of the respondents between the pre-morbid and post-morbid periods. The illness significantly affected the emotional status of the participants. CONCLUSION Relapse and readmission in psychiatric patients have a negative impact on socio-economic well-being of patients, family and the society. Efforts should be taken to provide early interventions.
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Affiliation(s)
- Caleb A Gbiri
- Federal Neuro-Psychiatric Hospital, Yaba, Lagos, Nigeria.
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Post-discharge services and psychiatric rehospitalization among children and youth. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:433-45. [PMID: 20063073 DOI: 10.1007/s10488-009-0263-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined risk and determinants of rehospitalization of children and adolescents (n = 186) following a first psychiatric hospitalization. It specifically examined the role of post-discharge services. Data were collected for a 30-month follow-up period through structured telephone interviews with caregivers and case record abstractions. 43% of youth experienced readmissions during the follow-up period. Risk of rehospitalization was highest during the first 30 days following discharge and remained elevated for 3 months. 72% of youth received 284 post-discharge services during the follow-up period, which significantly reduced the risk of rehospitalization. Longer first hospitalizations and a higher risk score at admission increased risk.
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Abstract
Predecessor research suggests that anything from 37% to 53% of hospitalized service users are readmitted within 12 months of discharge. This cycle of frequent admissions represents a serious challenge to clinicians and service users alike. Critically, much of the research in this field has relied exclusively on professional attributions for readmission with little acknowledgement of service user or patient viewpoints. This paper reports on a phenomenological study which used multiple data collection approaches to explore service user and clinician attributions for frequent hospitalization to an identified psychiatric unit over a 24-month index period. Methods included a retrospective review of multi-professional case notes, clinician and service user semi-structured interviews, and focus groups. Service users cited 'situational circumstances', rather than medically accepted relapse indicators such as 'non-adherence with prescribed medication' as the main reasons for readmission. Notable disagreement existed between clinician and service user data sources. Hospitalization is a complex, individually determined experience. Clinicians and service users have differing perspectives on the causal risk factors and this presents complications for those developing relapse prevention strategies. However, a shared appreciation of the multiple realities paves the way for the development of a conceptual risk-factor identification model which may serve as a guide to practitioners in relapse prevention.
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Affiliation(s)
- Tennyson Mgutshini
- Department of Baccalaureate Nursing Completion, Indiana State University, Indiana State University, Terre Haute, Indiana, USA.
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Johannessen HA, Dieserud G, Jakhelln F, Zahl PH, De Leo D. Changes in institutional psychiatric care and suicidal behaviour: a follow-up study of inpatient suicide attempters in Baerum, Norway. Soc Psychiatry Psychiatr Epidemiol 2009; 44:845-51. [PMID: 19247559 DOI: 10.1007/s00127-009-0006-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 01/30/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND During the past decades, extensive reformatory changes in institutional psychiatric care have been implemented in Norway. AIMS The objective of the present study was to investigate whether these changes have resulted in shortened length of psychiatric hospital stays for suicide attempters. Further, to examine if length of hospital stay and time period in which the patients received treatment were related to the risk of a repeated suicide attempt and/or committing suicide. METHODS All cases of suicide attempters hospitalised between 1984 and 2006 in the municipality of Baerum, a suburb outside Oslo, were examined. The period of observation was further subdivided in two time intervals on the basis of the de-institutionalisation of psychiatric care, which started to plateau in 1996. RESULTS Among 1,574 patients consecutively admitted to the local general hospital after a suicide attempt, 330 were admitted to inpatient psychiatric care. Patients admitted in the period 1996-2006 had significantly shorter hospital stays than patients in the preceding period 1984-1995 (Log Rank P < 0.001). Neither the time period of treatment variable nor the length of hospital stay variable was significantly associated with the risk of a repeated suicide attempt or suicide. CONCLUSIONS Psychiatric de-institutionalisation appears as not having affected suicide attempt repetition. It is possible that reduced length of hospital stay has been compensated by improved mental health care in general and extended outpatient services in particular.
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Affiliation(s)
- Håkon A Johannessen
- Division of Mental Health, Department of Suicide Research and Prevention, Norwegian Institute of Public Health, 0403, Oslo, Norway.
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Durbin J, Lin E, Layne C, Teed M. Is readmission a valid indicator of the quality of inpatient psychiatric care? J Behav Health Serv Res 2007; 34:137-50. [PMID: 17437186 DOI: 10.1007/s11414-007-9055-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 02/01/2007] [Indexed: 10/23/2022]
Abstract
Early return to hospital is a frequently measured outcome in mental health system performance monitoring yet its validity for evaluating quality of inpatient care is unclear. This study reviewed research conducted in the last decade on predictors of early readmission (within 30 to 90 days of discharge) to assess the association between this indicator and quality of inpatient psychiatric care. Only 13 studies met inclusion criteria. Results indicated that risk is greatest in the 30-day period immediately after discharge. There was modest support that attending to stability of clinical condition and preparing patients for discharge can protect against early readmission. A history of repeated admission increases risk, suggesting that special efforts are required to break the revolving door cycle. The authors identified a need for more standardization in measurement of client status at discharge and related care processes, more intervention studies on discharge practices, and studies of the effect of community care on early readmission.
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Affiliation(s)
- Janet Durbin
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, University of Toronto, 33 Russell Street, T310, Toronto, ON, M5S 2S1, Canada.
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Junghan UM, Brenner HD. Heavy use of acute in-patient psychiatric services: the challenge to translate a utilization pattern into service provision. Acta Psychiatr Scand Suppl 2006:24-32. [PMID: 16445478 DOI: 10.1111/j.1600-0447.2005.00713.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is an inequality in resource utilization among acute psychiatric in-patients. About 20-30% of them absorb 60-80% of the total resources allocated to this form of treatment. This study intends to summarize findings related to heavy in-patient service use and to illustrate them by means of utilization data for acute psychiatric wards. METHOD Longitudinal assessment of consecutive acute in-patients hospitalized for the first time. Analysis of individual utilization patterns by using latent class cluster analysis. RESULTS Four groups with different utilization patterns were found all including heavy service users. In most cases heavy service use was temporary and could only be poorly predicted. CONCLUSION Specific preventive interventions to contain heavy service use seem to be out of reach for the majority of high utilizing patients. However, services that have proven effective in reducing admissions to in-patient treatment and length of stay may nevertheless help to reduce heavy service use.
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Affiliation(s)
- U M Junghan
- University Hospital for Social and Community Psychiatry, Bern, Switzerland.
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