A sequence analysis of hospitalization patterns and service utilization in patients with major psychiatric disorders in China

Applying sequence analysis to uncover 'real-world' clinical pathways from routinely collected data: a systematic review

OBJECTIVES

This systematic review aims to elucidate the methodological practices and reporting standards associated with sequence analysis (SA) for the identification of clinical pathways in real-world scenarios, using routinely collected data.

STUDY DESIGN AND SETTING

We conducted a methodological systematic review, searching five medical and health databases: MEDLINE, PsycINFO, CINAHL, EMBASE and Web of Science. The search encompassed articles from the inception of these databases up to February 28, 2023. The search strategy comprised two distinctive sets of search terms, specifically focused on sequence analysis and clinical pathways.

RESULTS

19 studies met the eligibility criteria for this systematic review. Nearly 60% of the included studies were published in or after 2021, with a significant proportion originating from Canada (n = 7) and France (n = 5). 90% of the studies adhered to the fundamental SA steps. The optimal matching (OM) method emerged as the most frequently employed dissimilarity measure (63%), while agglomerative hierarchical clustering using Ward's linkage was the preferred clustering algorithm (53%). However, it is imperative to underline that a majority of the studies inadequately reported key methodological decisions pertaining to SA.

CONCLUSION

This review underscores the necessity for enhanced transparency in reporting both data management procedures and key methodological choices within SA processes. The development of reporting guidelines and a robust appraisal tool tailored to assess the quality of SA would be invaluable for researchers in this field.

Increasing person-centeredness in psychosis inpatient care: care consumption before and after a person-centered care intervention

BACKGROUND

Patients with psychotic disorders often need hospitalization with long stays. Person-centered care (PCC) has been shown to improve care quality and decrease the length of hospital stay in non-psychiatric settings. We carried out an educational intervention for inpatient staff, aiming to increase person-centeredness at a major Swedish psychosis clinic. The aim of this study was to test if the intervention could be associated with decreased length of hospital stay (LoS), involuntary stay (LoIS), and reduction in rapid readmissions.

METHODS

Data from the clinic's administrative registry were compared for patients with a discharge diagnosis within the schizophrenia-spectrum treated during the one-year periods before and after the PCC intervention.

RESULTS

Contrary to our hypotheses, a quantile regression estimated longer LoS post-intervention, median difference 10.4 d (CI 4.73-16.10). Neither age, sex nor diagnostic category were associated with LoS. Of all inpatient days, ∼80% were involuntary. While LoIS was numerically longer post-intervention, the difference did not reach significance in the final regression model (median difference 7.95 d, CI -1.40 to 17.31). Proportions with readmission within 2 weeks of discharge did not differ (7.7% vs 5.2%, n.s.).

CONCLUSIONS

Increased length of inpatient care was observed after the PCPC intervention. This could reflect an increased focus on the unmet needs of persons with serious psychotic conditions, but it needs to be explored in future research using a more rigorous study design.

TRIAL REGISTRATION

This study is part of a larger evaluation of Person-Centered Psychosis Care (PCPC), registered during data collection (after the study start, before analysis) at clinicaltrials.gov, identifier NCT03182283.

Relationship Between Emotional Intelligence, Self-Acceptance, and Positive Coping Styles Among Chinese Psychiatric Nurses in Shandong

Background

Nurses are facing increasing pressure due to the progressing of society, broadening of nursing service connotation, and increasing of the masses’ demand for medical treatment. Psychiatric nurses face suicides, violence, and lost along with other accidents involving patients with mental disorders under higher psychological pressure. A coping style, which is affected by individual emotions and cognition, is an essential psychological resource that allows individuals to regulate stress. The purpose of this study was to investigate the correlation between self-acceptance and the positive coping style of psychiatric nurses, and investigate the mediating role of emotional intelligence.

Methods

A total of 813 psychiatric nurses from six natural regions in Shandong Province were investigated using the Self-Acceptance Questionnaire (SAQ), Emotional Intelligence Scale (EIS), Simplified Coping Style Questionnaire (SCSQ), and self-compiled general information questionnaire.

Results

The total EIS score of psychiatric nurses was 3.848 ± 0.459. The highest score was for others’ emotional management (4.071 ± 0.548) and the lowest was for emotion perception (3.684 ± 0.483). EIS and positive coping style were statistically significant based on age, work experience, professional title, education level, and gender (p < 0.05, p < 0.01). Self-acceptance was statistically significant only for professional titles (F = 3.258, p = 0.021). Self-acceptance and emotional intelligence were positively correlated with positive coping style (r = 0.361, p < 0.01; r = 0.492, p < 0.01, respectively). The factors were also positively correlated with each other (r = 0.316, p < 0.01). Self-emotion management, others’ emotional management, emotion perception, self-acceptance, and education level jointly predicted positive coping styles (R² = 0.305, F = 60.476, p = 0.000). Emotional intelligence partially mediated the relationship between self-acceptance and positive coping styles, with a mediating effect of 16.3%.

Conclusion

Emotional intelligence and self-acceptance can promote positive coping styles and improve psychiatric nurses’ mental health.

Comorbidity combinations in schizophrenia inpatients and their associations with service utilization: A medical record-based analysis using association rule mining

BACKGROUND

Comorbidities are common among patients with schizophrenia yet the prevalence of comorbidity combinations and their associations with inpatient service utilization and readmission have been scarcely explored.

METHODS

Data were extracted from discharge summaries of patients whose primary diagnosis was schizophrenia spectrum disorders (ICD-10: F20-F29). We identified 30 most frequent comorbidities in patients' secondary diagnoses and then used the association rule mining (ARM) method to derive comorbidity combinations associated with length of stay (LOS), daily expense and one-year readmission.

RESULTS

The study included data from 8252 patients. The top five most common comorbidities were extrapyramidal syndrome (EPS, 44.58%), constipation (31.63%), common cold (21.80%), hyperlipidemia (20.99%) and tachycardia (19.13%). Most comorbidity combinations identified by ARM were significantly associated with longer LOS (≥70 days), few were associated with higher daily expenses, and fewer with readmission. The 3-way combination of common cold, hyperlipidemia and fatty liver had the strongest association with longer LOS (adjusted OR (aOR): 3.38, 95% CI: 2.12-5.38). The combination of EPS and mild cognitive disorder was associated with higher daily expense (≥700 RMB) (aOR: 1.67, 95% CI: 1.20-2.31). The combination of constipation, tachycardia and fatty liver were associated with higher 1-year readmission (aOR: 2.05, 95% CI: 1.03-4.09).

CONCLUSION

EPS, constipation, and tachycardia were among the most commonly reported comorbidities in schizophrenia patients in Beijing, China. Specific groups of comorbidities may contribute to higher inpatient psychiatric service utilization and readmission. The mechanism behind the associations and potential interventions to optimize service use warrant further investigation.

Frailty among inpatients with Schizophrenia: Status, influencing factors, and their correlation with quality of life

OBJECTIVE

This study aimed to understand frailty and its influencing factors in inpatients with Schizophrenia in Chengdu and to explore correlations between frailty and quality of life.

METHODS

From May to July 2022, inpatients with Schizophrenia were surveyed using a general information questionnaire, frailty phenotype (FP) scoring, the Self-Rating Depression Scale (SDS), the Mini-Mental State Examination (MMSE), and the SZ Quality of Life Scale (SQLS). Multivariate logistic regression was conducted to assess factors influencing frailty and multivariate linear regression was conducted to assess the factors influencing quality of life.

RESULTS

A total of 556 hospitalized patients with Schizophrenia were included and divided into three groups according to the degree of frailty, of which 153 cases (27.5%) were without frailty, 348 cases (62.6%) were in early frailty, and 55 cases (9.9%) were in frailty. Univariate analysis of age, history of falls during hospitalization, polypharmacy, compulsory treatment during hospitalization, self-reported health status, activity level, cognitive impairment, depressive symptoms, "psychology and society," "motivation and energy" and "symptoms and side-effects" showed statistically significant differences between the groups. Multinomial logistic regression showed that age, BMI, self-reported health, activity, cognitive impairment, motivation and energy, and symptoms and side-effects were influencing factors for frailty in hospitalized patients with Schizophrenia. Correlation analysis shows that frailty score positively correlated with SQLS score.

CONCLUSION

We found that frailty was prevalent and that frailty was positively correlated with SQLS scores in inpatients with Schizophrenia. To effectively manage the frailty of hospitalized patients with Schizophrenia, medical staff should pay attention to its influencing factors and quality of life.

Characteristics of hospitalized patients with depression and their relationship with the surrounding environment: A study in a class 3A hospital in Shanghai

The World Health Organization predicted that depression will become the second greatest disease burden after coronary heart disease by 2020. However, there are few quantitative studies on the spatial relationship between environmental factors and characteristics of patients with depression. In this paper, mathematical statistics, geographical information system and regression methods were used to conduct a quantitative analysis of the individual attributes of hospitalized patients with depression in a Class 3A hospital in Shanghai from 2013 to 2019 and to explore the relationship between individual attributes and circumjacent environmental factors. The results show that (1) the total number of patients with depression has increased in recent years, and the proportion of women was increased 2.5-fold compared with that of men. The risk was significantly increased in middle-aged and young adults aged 45–69 years compared with other age groups. The average hospitalization time was 20–30 days. The lower the level of education, the greater the risk of depression. (2) Within a certain spatial range, the closer to city parks and coffee shops, the lower the distribution density of depressed patients. (3) Medical insurance for patients with depression needs to implement a “people-oriented” differentiation policy. (4) Expanding urban public space, improving urban leisure and entertainment infrastructure, and introducing coffee shops into large-scale residential communities are three important strategies to prevent and treat depression.