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Singal S, Howell D, Hanna L, Tang SX, Van Meter A, Saito E, Kane JM, Michaels TI. Race-Based Disparities in the Frequency and Duration of Restraint Use in a Psychiatric Inpatient Setting. Psychiatr Serv 2024; 75:308-315. [PMID: 37855100 DOI: 10.1176/appi.ps.20230057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Patients' race and age have each been identified as risk factors for experiencing restraint events during psychiatric hospitalization. Restraint duration is also an important variable in determining disparities in treatment. To the authors' knowledge, no studies to date have examined the effect of the interaction of race and age on restraint use and duration in inpatient psychiatric settings. This retrospective chart review of electronic medical records of patients admitted between 2012 and 2019 sought to examine whether race and age interacted in predicting differences in the use and duration of restraints in a psychiatric inpatient setting. METHODS Logistic and hierarchical regression analyses were conducted on data from a sample of 29,739 adolescent (ages 12-17 years) and adult (ages ≥18 years) inpatients to determine whether the interaction of race and age group (adolescent or adult) significantly predicted a restraint event or differences in restraint duration. RESULTS Black (adjusted OR [AOR]=1.85) and multiracial (AOR=1.36) patients were more likely to experience a restraint event than were their White peers. Black race was also significantly (p=0.001) associated with longer restraint duration. No significant interaction was detected between race and age in predicting restraint events or duration. CONCLUSIONS Although the interaction between race and age did not predict restraint events or duration, the findings indicate racial disparities in the frequency and duration of restraint events among Black and multiracial individuals and may inform efforts to reduce these events.
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Affiliation(s)
- Sonali Singal
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Danielle Howell
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Lauren Hanna
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Sunny X Tang
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Anna Van Meter
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Ema Saito
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - John M Kane
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Timothy I Michaels
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
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Shields MC, Hollander MAG, Busch AB, Kantawala Z, Rosenthal MB. Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad017. [PMID: 38756837 PMCID: PMC10986256 DOI: 10.1093/haschl/qxad017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 05/18/2024]
Abstract
Following discharge from inpatient psychiatry, patients experience elevated suicide risk, unplanned readmission, and lack of outpatient follow-up visits. These negative outcomes might relate to patient-centered care (PCC) experiences while hospitalized. We surveyed 739 former patients of inpatient psychiatric settings to understand the relationship between PCC and changes in patients' trust, willingness to engage in care, and self-reported 30-day follow-up visits. We also linked PCC measures to facility-level quality measures in the Inpatient Psychiatric Facility Quality Reporting program. Relative to patients discharged from facilities in the top quartile of PCC, those discharged from facilities in the bottom quartile were more likely to experience reduced trust (predicted probability [PP] = 0.77 vs 0.46; P < .001), reduced willingness to go to the hospital voluntarily (PP = 0.99 vs 0.01; P < .001), and a lower likelihood of a 30-day follow-up (PP = 0.71 vs 0.92; P < .001). PCC was lower among patients discharged from for-profits, was positively associated with facility-level quality measures of 7- and 30-day follow-up and medication continuation, and was inversely associated with restraint use. Findings underscore the need to introduce systematic measurement and improvement of PCC in this setting.
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Affiliation(s)
- Morgan C Shields
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Mara A G Hollander
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard University, Harvard Medical School, Boston, MA 02115, United States
- McLean Hospital, Belmont, MA 02478, United States
| | - Zohra Kantawala
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard University, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
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Hung P, Probst JC, Shih Y, Ranganathan R, Brown MJ, Crouch E, Eberth JM. Rural-Urban Disparities in Quality of Inpatient Psychiatric Care. Psychiatr Serv 2022; 74:446-454. [PMID: 36321319 DOI: 10.1176/appi.ps.20220277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Rural residents have higher rates of serious mental illness than urban residents, but little is known about the quality of inpatient psychiatric care available to them locally or how quality may have changed in response to federal initiatives. This study aimed to examine differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals. METHODS This national retrospective study of 1,644 facilities examined facility-level annual quality-of-care data from the Inpatient Psychiatric Facility Quality Reporting program, 2015-2019. Facility location was categorized as urban, large rural, or small or isolated rural on the basis of zip code-level rural-urban commuting area codes. Generalized regression models were used to assess rural-urban differences in care quality (five continuity-of-care and two patient experience measures) and changes over time. RESULTS Rural inpatient psychiatric units performed better than urban units in nearly all domains. Improvements in quality of care (excluding follow-up care) were similar in rural and urban units. Rates of 30- and 7-day postdischarge follow-up care decreased in all hospitals but faster in rural units. Timely transmission of transition records was more frequent in small or isolated rural versus urban units (mean marginal difference=22.5, 95% CI=6.3-38.8). Physical restraint or seclusion use was less likely in rural than in urban units (OR=0.6, 95% CI=0.5-0.8). CONCLUSIONS Rural psychiatric units had better care quality at baseline (better follow-up care, better timely transmission of transition records, and lower rates of physical restraint use) than urban units, but during 2015-2019, follow-up care performance decreased overall and more in rural than urban units.
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Affiliation(s)
- Peiyin Hung
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Janice C Probst
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Yiwen Shih
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Radhika Ranganathan
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Monique J Brown
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Elizabeth Crouch
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Jan M Eberth
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
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Shields MC, Beaulieu ND, Lu S, Busch AB, Cutler DM, Chien AT. Increases in Inpatient Psychiatry Beds Operated by Systems, For-Profits, and Chains, 2010-2016. Psychiatr Serv 2022; 73:561-564. [PMID: 34433287 DOI: 10.1176/appi.ps.202100182] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study explored trends in the quantity of inpatient psychiatry beds and in facility characteristics. METHODS Using the National Bureau of Economic Research's Health Systems and Provider Database, the authors examined changes in the number of psychiatric facilities and beds, focusing on system ownership, profit status, facility type (general acute care versus freestanding), and affiliation with psychiatric hospital chains from 2010 to 2016. RESULTS The number of psychiatric beds was relatively unchanged from 2010 (N=112,182 beds) to 2016 (N=111,184). However, the number of beds operated by systems increased by 39.8% (N=15,803); for-profits, by 56.9% (N=8,572); and chains, by 16.7% (N=6,256). Net increases in beds were primarily concentrated in for-profit freestanding psychiatric hospitals. In 2016, most for-profit beds were part of chains (70.2%) and systems (61.3%). CONCLUSIONS Inpatient psychiatry has shifted toward increased ownership by systems, for-profits, and chains. Payers and policy makers should safeguard against profiteering, and future research should investigate the implications of these trends on quality of care.
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Affiliation(s)
- Morgan C Shields
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, Philadelphia (Shields); Department of Health Care Policy (Beaulieu, Busch) and Department of Pediatrics (Lu, Chien), Harvard Medical School, Boston; Division of General Pediatrics, Boston Children's Hospital, Boston (Lu, Chien); McLean Hospital, Belmont, Massachusetts (Busch); National Bureau of Economic Research, Cambridge, Massachusetts (Cutler); Department of Economics, Harvard University, Cambridge Massachusetts (Cutler)
| | - Nancy D Beaulieu
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, Philadelphia (Shields); Department of Health Care Policy (Beaulieu, Busch) and Department of Pediatrics (Lu, Chien), Harvard Medical School, Boston; Division of General Pediatrics, Boston Children's Hospital, Boston (Lu, Chien); McLean Hospital, Belmont, Massachusetts (Busch); National Bureau of Economic Research, Cambridge, Massachusetts (Cutler); Department of Economics, Harvard University, Cambridge Massachusetts (Cutler)
| | - Sifan Lu
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, Philadelphia (Shields); Department of Health Care Policy (Beaulieu, Busch) and Department of Pediatrics (Lu, Chien), Harvard Medical School, Boston; Division of General Pediatrics, Boston Children's Hospital, Boston (Lu, Chien); McLean Hospital, Belmont, Massachusetts (Busch); National Bureau of Economic Research, Cambridge, Massachusetts (Cutler); Department of Economics, Harvard University, Cambridge Massachusetts (Cutler)
| | - Alisa B Busch
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, Philadelphia (Shields); Department of Health Care Policy (Beaulieu, Busch) and Department of Pediatrics (Lu, Chien), Harvard Medical School, Boston; Division of General Pediatrics, Boston Children's Hospital, Boston (Lu, Chien); McLean Hospital, Belmont, Massachusetts (Busch); National Bureau of Economic Research, Cambridge, Massachusetts (Cutler); Department of Economics, Harvard University, Cambridge Massachusetts (Cutler)
| | - David M Cutler
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, Philadelphia (Shields); Department of Health Care Policy (Beaulieu, Busch) and Department of Pediatrics (Lu, Chien), Harvard Medical School, Boston; Division of General Pediatrics, Boston Children's Hospital, Boston (Lu, Chien); McLean Hospital, Belmont, Massachusetts (Busch); National Bureau of Economic Research, Cambridge, Massachusetts (Cutler); Department of Economics, Harvard University, Cambridge Massachusetts (Cutler)
| | - Alyna T Chien
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, Philadelphia (Shields); Department of Health Care Policy (Beaulieu, Busch) and Department of Pediatrics (Lu, Chien), Harvard Medical School, Boston; Division of General Pediatrics, Boston Children's Hospital, Boston (Lu, Chien); McLean Hospital, Belmont, Massachusetts (Busch); National Bureau of Economic Research, Cambridge, Massachusetts (Cutler); Department of Economics, Harvard University, Cambridge Massachusetts (Cutler)
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