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Normand SL, Zelevinsky K, Finnerty M, Leckman-Westin E, Chen Q, Jeong J, Abing H, Tsuei J, Horvitz-Lennon M. Racial-Ethnic Disparities in Quality of Care Among Medicaid Beneficiaries With Schizophrenia. Psychiatr Serv 2024; 75:969-978. [PMID: 38863327 DOI: 10.1176/appi.ps.20230564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE The authors sought to update and expand the evidence on the quality of health care and disparities in care among Medicaid beneficiaries with schizophrenia. METHODS Adult beneficiaries of New York State Medicaid with schizophrenia receiving care during 2016-2019 were identified. Composite quality scores were derived from item response theory models by using evidence-based indicators of the quality of mental and general medical health care. Risk-adjusted racial-ethnic differences in quality were estimated and summarized as percentiles relative to White beneficiaries' mean quality scores. RESULTS The study included 71,013 beneficiaries; 42.8% were Black, 22.9% Latinx, 27.4% White, and 6.9% other race-ethnicity. Overall, 68.8% had a mental health follow-up within 30 days of discharge, and 90.2% had no preventable hospitalizations for chronic obstructive pulmonary disease or asthma. Among beneficiaries receiving antipsychotic medications, medication adherence was adequate for 43.7%. Fourteen indicators for mental and general medical health care quality yielded three composites: two for mental health care (pharmacological and ambulatory) and one for acute mental and general medical health care. Mean quality of pharmacological mental health care for Black and Latinx beneficiaries was lower than for White beneficiaries (39th and 44th percentile, respectively). For Black beneficiaries, mean quality of ambulatory mental health care was also lower (46th percentile). In New York City, Black beneficiaries received lower-quality care in all domains. The only meaningful group difference in the quality of acute mental and general medical health care indicated higher-quality care for individuals with other race-ethnicity. CONCLUSIONS Disparities in the quality of Medicaid-financed health care persist, particularly for Black beneficiaries. Regional differences merit further attention.
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Affiliation(s)
- Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Katya Zelevinsky
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Molly Finnerty
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Emily Leckman-Westin
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Qingxian Chen
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Junghye Jeong
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Haley Abing
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Jeannette Tsuei
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Marcela Horvitz-Lennon
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
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Barruel D, Perozziello A, Lefèvre H, Msellati A, Launay C, Dauriac-Le Masson V. Predictors of the length of stay in psychiatric inpatient units: a retrospective study for the Paris Psychiatry Hospital Group. Front Psychiatry 2024; 15:1463415. [PMID: 39359856 PMCID: PMC11445158 DOI: 10.3389/fpsyt.2024.1463415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 08/14/2024] [Indexed: 10/04/2024] Open
Abstract
Objective Shortening the length of hospital stay (LOS) has become a major challenge for psychiatric hospitals in reducing unnecessary costs and improving the patient healthcare experience. We investigated the key factors associated with a long psychiatric hospitalization. Method This was a retrospective study of 8,870 full-time psychiatric hospital stays (6,216 patients) in the Paris Psychiatry Hospital Group, with a discharge in 2022. We used machine learning tools and univariate and multivariate methods to explore the impact of demographic, pathway-related, and clinical variables on the LOS. Results LOS >30 days was associated with age >55 years {odds ratio [OR] =2 [95% confidence interval 1.7-2.3]}, admission from outside the sectorization zone [OR=1.2 (1.1-1.3)], admission via a psychiatric emergency unit [OR, 1.2 (1.1-1.4)], and some clinical severity markers, such as psychotic disorder diagnosis [OR, 1.5 (1.3-1.7)], mandatory care [request of a third party, OR, 2.5 (2.1-2.9); case of imminent danger, OR, 2.3 (1.9-2.7)], the presence of seclusion and mechanical restraint measures (highlighting the positive effect of restraint duration), the somatic comorbidity for female sex [OR, 1.4 (1.2-1.7)], and treatment resistance [OR, 1.4 (1.2-1.6)]. Conversely, LOS ≤30 days was associated with being in a relationship [OR, 0.6 (0.5-0.8)], admission during a travel-related psychiatric episode [OR, 0.5 (0.3-0.6)], and personality and behavior disorders [OR, 0.7 (0.6-0.9)]. We found no significant association for features such as sex and a lack of treatment compliance. Conclusion To our knowledge, this is the first recent study to investigate and highlight the impact of factors related to various illness severity markers, medication adherence, and patient journeys on the length of psychiatric hospital stay. A better understanding of long-stay risk factors might be helpful for optimizing the allocation of medical resources and anticipating tailored therapeutic programs.
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Affiliation(s)
- David Barruel
- Groupement Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Anne Perozziello
- Groupement Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Hassina Lefèvre
- Groupement Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Annie Msellati
- Groupement Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Corine Launay
- Groupement Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Valérie Dauriac-Le Masson
- Groupement Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
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Martin E, Purushothaman S, Ballard E, Blake JA, Burke K, Scott JG. Electroconvulsive therapy in a tertiary Australian mental health facility between 2009 and 2020. Aust N Z J Psychiatry 2024; 58:713-720. [PMID: 38831553 DOI: 10.1177/00048674241256839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Despite electroconvulsive therapy being one of the most effective treatments in psychiatry, few studies report trends in the provision of electroconvulsive therapy over time. This study aims to investigate the use of electroconvulsive therapy between 2009 and 2020 in an Australian public tertiary mental health facility, and to describe the electroconvulsive therapy patient population and change in courses of treatment. METHODS Routinely collected data for 677 patients who received 1669 electroconvulsive therapy courses of treatment at an Australian public tertiary mental health facility between 2009 and 2020 were examined. RESULTS The provision of acute electroconvulsive therapy was stable across the study period; however, the number of maintenance electroconvulsive therapy courses commenced declined over the study. Schizophrenia was the most common indication for index treatment (37.4%). The majority of patients (85.7%) received acute electroconvulsive therapy only. Voluntary provision of electroconvulsive therapy declined over the study period, reducing from 44.9% in 2009 to 16.3% in 2020. CONCLUSION Over the study period, there was a significant reduction in the number of maintenance electroconvulsive therapy courses commenced, and a large increase in involuntary treatment. The provision of electroconvulsive therapy was more likely to occur in males with a diagnosis of schizophrenia. Further studies are needed to generate a greater understanding of the factors influencing the provision of electroconvulsive therapy within differing geographical, social and healthcare landscapes.
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Affiliation(s)
- Emily Martin
- Metro North Mental Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
| | | | - Emma Ballard
- Brain and Mental Health, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Julie A Blake
- Brain and Mental Health, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Child and Youth Mental Health Research, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Child and Youth Mental Health Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Kylie Burke
- Metro North Mental Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
- School of Psychology, The University of Queensland, South Brisbane, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, Institute for Social Science Research, The University of Queensland, South Brisbane, QLD, Australia
| | - James G Scott
- Brain and Mental Health, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
- Child and Youth Mental Health Research, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Child and Youth Mental Health Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Xu F, Cheng P, Xu J, Wang X, Jiang Z, Zhu H, Fan H, Wang Q, Gao Q. Influencing factors of length of stay among repeatedly hospitalized patients with mood disorders: a longitudinal study in China. Ann Gen Psychiatry 2024; 23:15. [PMID: 38664741 PMCID: PMC11046813 DOI: 10.1186/s12991-024-00497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Patients with mood disorders usually require repeated and prolonged hospitalization, resulting in a heavy burden on healthcare resources. This study aims to identify variables associated with length of stay(LOS) of repeatedly hospitalized patients with mood disorders and to provide information for optimizing psychiatry management and healthcare resource allocation. METHODS Electronic medical records (EMRs) of repeatedly hospitalized patients with mood disorders from January 2010 to December 2018 were collected and retrospectively analyzed. Chi-square and t-test were adopted to investigate the differences in characteristics between the two groups of short LOS and long LOS. Generalized estimating equation (GEE) was conducted to investigate potential factors influencing LOS. RESULTS A total of 2,009 repeatedly hospitalized patients with mood disorders were enrolled, of which 797 (39.7%) had a long LOS and 1,212 (60.3%) had a short LOS. Adverse effects of treatment, continuous clinical manifestation, chronic onset type, suicide attempt, comorbidity and use of antidepressants were positively associated with long LOS among all repeatedly hospitalized patients with mood disorders (P < 0.050). For patients with depression, factors associated with long LOS consisted of age, monthly income, adverse effects of treatment, continuous clinical manifestation, suicide attempt and comorbidity (P < 0.050). Whereas, for patients with bipolar disorder (BD), adverse effects of treatment, four or more hospitalizations and use of antidepressants contributed to the long LOS (P < 0.050). Influencing factors of LOS also vary among patients with different effectiveness of treatment. CONCLUSION The LOS in repeatedly hospitalized patients with mood disorders was influenced by multiple factors. There were discrepancies in the factors affecting LOS in patients with different diagnoses and effectiveness of treatment, and specific factors should be addressed when evaluating the LOS.
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Affiliation(s)
- Feng Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Jiaying Xu
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Zhen Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Hua Fan
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Qian Wang
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China.
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Paliweni-Zwane TI, Modisane LN, Grobler GP. Factors associated with long hospitalisation for psychotic disorder patients in an acute ward: Tertiary care hospital. S Afr J Psychiatr 2024; 30:2049. [PMID: 38726331 PMCID: PMC11079344 DOI: 10.4102/sajpsychiatry.v30i0.2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
Background The average length of stay is often used to indicate health system efficiency; shorter stays are associated with reduced costs. In South Africa, mental healthcare expenditure is spent on inpatient care. Aim To identify factors associated with a long stay in an acute psychiatric unit. Setting A tertiary hospital. Methods A case-control study review of inpatients diagnosed with psychotic symptoms was used. Sample was divided into two groups, length of stay (LOS) (LOS greater than 21 days, LOS less than 14 days). Total of 82 patients were divided into short stay group (SSG, n = 23) and long stay group (LSG) (n = 59). A comparison of demographic, clinical and system variables was conducted. Results In demographics, LSG had fewer men compared to SSG (78.3%) and differed statistically from LSG with p = 0.05. Long stay groups were older in comparison to SSG with a p = 0.02. Illicit substance use in LSG was 44.1% and statistically less than SSG (73.91%; p = 0.02). A high proportion of LSG had medical or surgical and psychiatric comorbidities (67.8%) compared to SSG (43.5%) (p = 0.04). A total of 95% patients in SSG had family support. Conclusion Longer stay was found to be associated with older females with primary psychotic disorders. Comorbidities with less availability of family support were associated with younger males presenting with psychotic symptoms that may be related to illicit substances that respond to rapid stabilisation. Contribution Active surveillance of medical comorbidities amongst older female patients is necessary for early liaison services to reduce their length of stay.
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Affiliation(s)
- Tshepiso I Paliweni-Zwane
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Lucas N Modisane
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Gerhard P Grobler
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
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Light J, Ruh C, Ott M, Banker C, Meaney D, Doloresco F, Noyes K. The Effect of Pharmacy-Led Medication Reconciliation on Odds of Psychiatric Relapse at a Community Hospital. J Pharm Pract 2024; 37:391-398. [PMID: 36314582 DOI: 10.1177/08971900221137100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient's medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital's outpatient CPEP within 30-days (P = .012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P = .024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings.
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Affiliation(s)
- Jamie Light
- Erie County Medical Center, Buffalo, NY, USA
| | | | - Michael Ott
- Erie County Medical Center, Buffalo, NY, USA
| | - Christopher Banker
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Drake Meaney
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Fred Doloresco
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Katia Noyes
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
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da Rocha HA, Reis IA, Cherchiglia ML. Early and Frequent Psychiatric Readmissions in a Brazilian Cohort of Hospitalized Patients Between 2001 and 2013. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:147-161. [PMID: 37971543 DOI: 10.1007/s10488-023-01322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To characterize the profile of patients who were readmitted for mental and behavioral disorders, in the Brazilian Unified Health System, from 2001 to 2014, and the factors associated with early and frequent readmission. METHOD A retrospective, non-concurrent cohort study of patients admitted with a primary diagnosis of mental or behavioral disorders, from 2001 to 2014. This study selected demographic variables and clinical variables, as well as variables related to the characteristics of the hospitals. Poisson Regression methods with a robust variance estimator were used to estimate the incidence rate ratio (IRR) for each of the outcomes. RESULTS Early readmission occurred for 6.8% of the patients and frequent readmission for 8.3%. Characteristics such as being male, younger, with a diagnosis of a bipolar disorder, and admitted to a specialized hospital show a higher IRR for early readmission. The occurrence of early readmission was the most heavily associated characteristic with an increased rate of early readmission, and the magnitude of this increase depends on the patient's age. CONCLUSION Early and frequent readmissions are linked to patients' demographics, clinical information and health system's organization. Early readmission should be a priority in treatment planning to prevent frequent readmissions due to its strong association.
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Affiliation(s)
- Hugo André da Rocha
- Faculdade de Medicina. Programa de Pós- Graduação em Saúde Pública. Belo Horizonte, Universidade Federal de Minas Gerais, Minas Gerais, Brasil.
| | - Ilka Afonso Reis
- Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Mariangela Leal Cherchiglia
- Faculdade de Medicina. Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Ma CF, Chien WT, Luo H, Bressington D, Chen EYH, Chan SKW. Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong: A Comparative Population-Based Study. J Nerv Ment Dis 2023; 211:968-973. [PMID: 38015187 DOI: 10.1097/nmd.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 (COVID-19), and a large-scale social unrest happened in 2019. These were stressful societal events that influenced the mental well-being of the public. We aimed to explore the impact of these events on psychiatric admissions in Hong Kong. Socioeconomic and population-based psychiatric hospital admission data were retrieved from the government and Hospital Authority. Negative binomial time-series regression analysis was applied and we found overall significant reductions of psychiatric admissions during both the SARS and COVID-19 periods (-7.4% to -16.8%). Particularly, the admissions for unipolar disorders (-16.2% to -39.7%) and neuroses (-20.9% to -31.9%) were greatly reduced during the infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was seen during the social unrest period. These findings support introducing early and targeted community mental health care strategies to the vulnerable people during the stressful societal events.
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Affiliation(s)
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, Australia
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Khammarnia M, Bagherbarahouei F, Ansari-Moghaddam A. Length of Hospital Stay and Its Related Factors in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1877-1888. [PMID: 38033834 PMCID: PMC10682571 DOI: 10.18502/ijph.v52i9.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/09/2022] [Indexed: 12/02/2023]
Abstract
Background One of the effective indicators used to determine the efficiency and optimal use of hospital resources is the length of stay (LOS). Then, we aimed to determine LOS and its related factors in Iran. Methods A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, PubMed, SID, MagIran, and Medlib from 1995 to 2022 using a combination of medical subject. STATA version 11 used for data analysis. Results Overall, 75 (cross-sectional, cohort, and case-control) reports were identified. The average length of stay in Iranian hospitals was 6.7 (95% CI: 5.32 -7.74) d. There was a significant relationship between the length of stay in the hospital and different wards of hospital (P=0.001). The average of men' LOS was longer than women were [6.9 (95% CI: 5.32 -7.74) vs. 3.9 (95% CI: 1.67-9.41)]. Moreover, the average LOS before and after the Health Transformation Plan (HTP) in Iran has changed, so that it has increased from 5.8 (95% CI: 4.39 -7.86) to 7.1 (95% CI: 5.59 -9.25) d after HTP (P=0.30). Conclusion The average length of stay of patients in Iranian hospitals is more than the expected index of the Ministry of Health and Medical Education and is in the unfavorable range (> four days). Moreover, considering the direct effect of the type of departments on LOS; therefore, hospital managers should pay more attention to hospital processes using new process-oriented and customer-oriented management approaches.
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Affiliation(s)
- Mohammad Khammarnia
- Department of Health Care Management, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fatemeh Bagherbarahouei
- Student Research Committee, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran
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Russolillo A, Moniruzzaman A, Carter M, Raudzus J, Somers JM. Association of homelessness and psychiatric hospital readmission-a retrospective cohort study 2016-2020. BMC Psychiatry 2023; 23:459. [PMID: 37353747 PMCID: PMC10288711 DOI: 10.1186/s12888-023-04945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND A large proportion of adult psychiatric inpatients experience homelessness and are often discharged to unstable accommodation or the street. It is unclear whether homelessness impacts psychiatric hospital readmission. Our primary objective was to examine the association between homelessness and risk for 30-day and 90-day readmission following discharge from a psychiatric unit at a single urban hospital. METHODS A retrospective cohort study involving health administrative data among individuals (n = 3907) in Vancouver, Canada with an acute psychiatric admission between January 2016 and December 2020. Participants were followed from the date of index admission until censoring (December 30, 2020). Homelessness was measured at index admission and treated as a time-varying exposure. Adjusted Hazard Ratios (aHRs) of acute readmission (30-day and 90-day) for psychiatric and substance use disorders were estimated using multivariable Cox proportional hazards regression. RESULTS The cohort comprised 3907 individuals who were predominantly male (61.89%) with a severe mental illness (70.92%), substance use disorder (20.45%) and mean age of 40.66 (SD, 14.33). A total of 686 (17.56%) individuals were homeless at their index hospitalization averaging 19.13 (21.53) days in hospital. After adjusting for covariates, patients experiencing homelessness had a 2.04 (1.65, 2.51) increased rate of 30-day readmission and 1.65 (1.24, 2.19) increased rate of 90-day readmission during the observation period. CONCLUSIONS Homelessness was significantly associated with increased 30-day and 90-day readmission rates in a large comprehensive sample of adults with mental illness and substance use disorders. Interventions to reduce homelessness are urgently needed. QUESTION Is homelessness associated with risk for 30-day and 90-day psychiatric hospital readmission? FINDINGS In this retrospective cohort study of 3907 individuals, homelessness at discharge was associated with increased 30-day and 90-day psychiatric readmission. MEANING Housing status is an important risk factor for hospital readmission. High-quality interventions focused on housing supports have the potential to reduce psychiatric readmission.
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Affiliation(s)
- Angela Russolillo
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada.
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada.
| | - Akm Moniruzzaman
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada
| | - Michelle Carter
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada
| | - Julia Raudzus
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada
| | - Julian M Somers
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada
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Ziltener T, Moeller J, Lieb R, Meyer AH, Lang UE, Huber CG. Therapeutic leave and direct inpatient healthcare costs in inpatients with mental illness. J Psychiatr Res 2023; 162:187-192. [PMID: 37172508 DOI: 10.1016/j.jpsychires.2023.05.023] [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] [Received: 07/05/2022] [Revised: 03/21/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
AIMS Balancing the economic costs related to mental illness is a pressing matter globally. Scarce monetary and staff resources impose an ongoing challenge. Therapeutic leaves (TL) are an established clinical tool in psychiatry possibly improving therapy outcome and potentially lowering direct mental healthcare costs in the long term. We thus examined the association between TL and direct inpatient healthcare costs. METHODS We analyzed the association between the number of TL and direct inpatient healthcare costs in a sample of 3151 inpatients, using a tweedie multiple regression model, including eleven confounders. Using multiple linear (bootstrap) and logistic regression models we assessed the robustness of our results. RESULTS The tweedie model showed that the number of TL was associated with lower costs following the initial inpatient stay (B = -.141, CI 95% = [-0.225, -.057], p < 0.001). Results of the multiple linear and the logistic regression models matched those of the tweedie model. CONCLUSION Our findings suggest a link between TL and direct inpatient healthcare costs. TL might lower direct inpatient healthcare costs. In the future RCTs might examine whether an increased utilization of TL leads to a reduction of outpatient treatment costs and evaluate the association of TL with outpatient treatment costs and indirect costs. The systematic use of TL during inpatient treatment could reduce healthcare costs following the initial inpatient stay which is highly relevant due to global rise of mental illness and the associated financial pressure on healthcare systems.
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Affiliation(s)
- Tiziana Ziltener
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH-4002, Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH-4055, Basel, Switzerland.
| | - Julian Moeller
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH-4002, Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH-4055, Basel, Switzerland
| | - Roselind Lieb
- University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH-4055, Basel, Switzerland
| | - Andrea H Meyer
- University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH-4055, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH-4002, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH-4002, Basel, Switzerland
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Radhamony R, Cross WM, Townsin L, Banik B. Perspectives of culturally and linguistically diverse (CALD) community members regarding mental health services: A qualitative analysis. J Psychiatr Ment Health Nurs 2023. [PMID: 36947100 DOI: 10.1111/jpm.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant, refugee and asylum seeker populations worldwide are at high risk of mental health issues National mental health policies call for recognising Australian society's multicultural characteristics to ensure adequate mental health services to CALD communities Several barriers exist for people from CALD communities in Victoria to access and utilise mental health services Improving mental health professionals' knowledge of mental health service provision and cultural responsiveness can enhance CALD community access to services. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We analysed the perspectives of people from CALD communities in Victoria regarding their needs and experiences with mental health services. Participants reported diverse perceptions and understanding of mental health issues and services Various challenges were identified regarding health service utilisation for the CALD community in Victoria, including language barriers, stigma towards mental health issues, mental health illiteracy, distrust and lack of familiarity with mainstream mental health services. These challenges were acknowledged by community members even after a long residence in Australia The data generated on the beliefs about mental health issues and consequent help-seeking behaviours highlight the importance of culturally sensitive targeted prevention and early intervention strategies and ongoing commitment to building mental health literacy in the wider community WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The information from the study can be adapted for quality improvement and culturally responsive practices The strategies for effective service delivery drawn by this paper can be a comprehensive resource tool for mental health professionals, organisations and policymakers The findings imply that CALD mental health service users and their families will likely benefit from improved service assessment and quality of mental health care and equity when MHNs undertake cultural competence training and bring that into their practice. ABSTRACT INTRODUCTION: Victoria is one of the most multicultural states in Australia. Many CALD communities in Victoria may have encountered complicated migration journeys and complex life stressors during their initial settlement, leading to adverse mental health concerns. This diversity necessitates public policy settings to ensure equity and access in health services planning and delivery. While the MH policies and services take cultural diversity into account, there needs to be more implementation of those components of MH policies that relate to the particular needs of various CALD communities in Victoria. Even though mental health services prevent and address mental health issues, many barriers can impair CALD community access and utilisation of mental health services. Furthermore, the recent Royal Commission inquiry into the Victorian Mental Health system drives a renewed policy imperative to ensure meaningful engagement and cultural safety of all people accessing and utilising mental health services (Department of Health, 2023). AIM This study focused on the perspectives of people from CALD communities in Victoria regarding their mental health service needs, understandings of and experiences with mental health services to prepare an education package for mental health nurses as part of a larger multi-method research project. METHOD A qualitative descriptive design was used to collect and analyse the perspectives of 21 participants in Victoria, using telephone interviews, followed by thematic analysis. RESULTS The themes and sub-themes identified were: Settling issues; Perceptions of understanding of mental health issues (help-seeking attitudes toward mental health issues; the need for CALD community education); perceived barriers to accessing and utilising mental health services in Victoria (socio-cultural and language barriers; stigma, labelling and discrimination; knowledge and experience of accessing health facilities); experience with mental health services and professionals. DISCUSSION Community participation, mental health professional education and robust research regarding the mental health needs of CALD people are some of the recommended strategies to improve access and utilisation of mental health services in Victoria. IMPLICATIONS FOR PRACTICE The current study can contribute to the existing knowledge, understanding, practice and quality improvement as it vividly portrays the issues of various CALD communities in Victoria. The findings of this study imply that CALD MH service users and their families are likely to benefit in terms of improved service assessment and quality of MH care and equity when MHNs undertake CC training and bring that into their practice.
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Affiliation(s)
- Reshmy Radhamony
- Institute of Health and Wellbeing, Federation University, Berwick, Australia
| | | | - Louise Townsin
- Federation University, Berwick, Australia
- Torrens University, Adelaide, South Australia
| | - Biswajit Banik
- Institute of Health and Wellbeing, Federation University, Berwick, Australia
- Manna Institute, Regional Australia Mental Health Research and Training Institute, A project of Regional University Network (RUN), led by the University of New England, Armidale, NSW, Australia
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13
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Suesse B, Lago L, Westley-Wise V, Masso M, Cuenca J, Pai N. Application of mixture distributions for identifying thresholds of frequent and high inpatient mental health service use in longitudinal data. J Ment Health 2023; 32:33-42. [PMID: 33565342 DOI: 10.1080/09638237.2021.1875407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is a need for greater understanding about frequent and high use of inpatient mental health services, and those with ongoing increased needs. Most studies employ a threshold of frequent use (e.g. numbers of admissions) and high use (e.g. lengthy stays) without justification. AIMS To identify model-driven thresholds for frequent/high inpatient mental health service use and contrast characteristics of patients identified using various models and thresholds. METHOD Retrospective population-based study using 12 years of longitudinal data for 5631 patients admitted with a mental health diagnosis. Two-component negative binomial and poisson mixture (truncated/untruncated) models identified thresholds for frequent/high use in a 12-month period. RESULTS The two-component negative binomial mixture model resulted in the best model fit. Using negative binomial-derived thresholds, 5.3% of patients had a period of frequent use (admitted six or more times), 15.8% of high use (hospitalised for 45 or more days) and 3.5% of heavy use (both frequent and high use). The prevalence of specific mental health disorders (e.g. mood disorder and schizophrenia) among frequent and high use cohorts varied across thresholds. CONCLUSIONS This model-driven approach can be applied to identify thresholds in other cohorts. Threshold choice may depend on the magnitude and focus of potential interventions.
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Affiliation(s)
- Bianca Suesse
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Victoria Westley-Wise
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia.,Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Malcolm Masso
- Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Jose Cuenca
- Research Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Nagesh Pai
- Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong (UOW), Wollongong, NSW, Australia
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14
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Zhou H, Ngune I, Albrecht MA, Della PR. Risk factors associated with 30-day unplanned hospital readmission for patients with mental illness. Int J Ment Health Nurs 2023; 32:30-53. [PMID: 35976725 DOI: 10.1111/inm.13042] [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] [Accepted: 07/05/2022] [Indexed: 01/14/2023]
Abstract
Unplanned hospital readmission rate is up to 43% in mental health settings, which is higher than in general health settings. Unplanned readmissions delay the recovery of patients with mental illness and add financial burden on families and healthcare services. There have been efforts to reduce readmissions with a particular interest in identifying patients at higher readmission risk after index admission; however, the results have been inconsistent. This systematic review synthesized risk factors associated with 30-day unplanned hospital readmissions for patients with mental illness. Eleven electronic databases were searched from 2010 to 30 September 2021 using key terms of 'mental illness', 'readmission' and 'risk factors'. Sixteen studies met the selection criteria for this review. Data were synthesized using content analysis and presented in narrative and tabular form because the extracted risk factors could not be pooled statistically due to methodological heterogeneity of the included studies. Consistently cited readmission predictors were patients with lower educational background, unemployment, previous mental illness hospital admission and more than 7 days of the index hospitalization. Results revealed the complexity of identifying unplanned hospital readmission predictors for people with mental illness. Policymakers need to specify the expected standards that written discharge summary must reach general practitioners concurrently at discharge. Hospital clinicians should ensure that discharge summary summaries are distributed to general practitioners for effective ongoing patient care and management. Having an advanced mental health nurse for patients during their transition period needs to be explored to understand how this role could ensure referrals to the general practitioner are eventuated.
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Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Perth Children's Hospital, Western Australia, Australia.,Curtin School of Nursing, Curtin University, Western Australia, Australia
| | - Irene Ngune
- School of Nursing and Midwifery, Edith Cowan University, Western Australia, Australia
| | - Matthew A Albrecht
- Curtin School of Nursing, Curtin University, Western Australia, Australia
| | - Phillip R Della
- Curtin School of Nursing, Curtin University, Western Australia, Australia
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15
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Berardelli I, Sarubbi S, Rogante E, Erbuto D, Cifrodelli M, Giuliani C, Calabrò G, Lester D, Innamorati M, Pompili M. Exploring risk factors for re-hospitalization in a psychiatric inpatient setting: a retrospective naturalistic study. BMC Psychiatry 2022; 22:821. [PMID: 36550540 PMCID: PMC9783999 DOI: 10.1186/s12888-022-04472-3] [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] [Received: 06/06/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The reduction of multiple psychiatric hospitalizations is an important clinical challenge in mental health care. In fact, psychiatric re-hospitalization negatively affects the quality of life and the life expectancy of patients with psychiatric disorders. For these reasons, identifying predictors of re-hospitalization is important for better managing psychiatric patients. The first purpose of the present study was to examine the readmission rate in a large sample of inpatients with a psychiatric disorder. Second, we investigated the role of several demographical and clinical features impacting re-hospitalization. METHOD: This retrospective study enrolled 1001 adult inpatients (510 men and 491 women) consecutively admitted to the University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome between January 2018 and January 2022. To identify risk factors for psychiatric re-hospitalization, we divided the sample into 3 subgroups: the Zero-Re group which had no readmission after the index hospitalization, the One-Re group with patients re-admitted only once, and the Two-Re with at least two re-admissions. RESULTS: The groups differed according to previous hospitalizations, a history of suicide attempts, age at onset, and length of stay. Furthermore, the results of the regression model demonstrated that the Two-Re group was more likely to have a history of suicide attempts and previous hospitalizations. DISCUSSION These results indicate the importance of assessing risk factors in psychiatric hospitalized patients and implementing ad hoc prevention strategies for reducing subsequent re-hospitalizations.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189, Rome, Italy.
| | - Salvatore Sarubbi
- grid.7841.aDepartment of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università, 30, 00185 Rome, Italy
| | - Elena Rogante
- grid.7841.aDepartment of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università, 30, 00185 Rome, Italy
| | - Denise Erbuto
- grid.7841.aDepartment of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - Mariarosaria Cifrodelli
- grid.7841.aPsychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital, Psychiatry Unit, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - Carlotta Giuliani
- grid.7841.aPsychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital, Psychiatry Unit, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - Giuseppa Calabrò
- grid.7841.aDepartment of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - David Lester
- grid.262550.60000 0001 2231 9854Psychology Program, Stockton University, Galloway, NJ USA
| | - Marco Innamorati
- grid.459490.50000 0000 8789 9792Department of Human Sciences, European University of Rome, Via Degli Aldobrandeschi 190, 00163 Rome, Italy
| | - Maurizio Pompili
- grid.7841.aDepartment of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189 Rome, Italy
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Grove JL, April LY, Evan MK. Social Support as Protective Factor for Suicidal Ideation during Treatment for Substance Abuse: Differential Effects across Treatment Modalities. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2022. [DOI: 10.1016/j.crbeha.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Real-world effectiveness of long-acting injectable antipsychotics to reduce 90-day and annual readmission in psychotic disorders: insights from a state psychiatric hospital. CNS Spectr 2022; 27:626-633. [PMID: 33938426 DOI: 10.1017/s109285292100050x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND To evaluate the effectiveness of long-acting injectable antipsychotics (LAI-a) in reducing the 90-day and annual readmission rates in schizophrenia inpatients. METHODS We conducted a cross-sectional study and included 180 adult patients with psychotic disorders discharged from 2018 to 2019 at a state psychiatric hospital. Descriptive statistics were used to measure the differences between the readmit and nonreadmit cohorts. Logistic regression model was used to measure the odds ratio (OR) for 90-day and annual readmission and was controlled for potential readmission risk factors. RESULTS A lower proportion of patients receiving LAI-a were readmitted within 90-day (28.6%) and 1-year (32.4%) periods. Patients receiving LAI-a had lower odds of association for 90-day (OR 0.36, 95% confidence intervals [CI] 0.139-0.921) and annual (OR 0.35, 95% CI 0.131-0.954) readmissions compared to those discharged on oral antipsychotics. A higher proportion of inpatients who received fluphenazine LAI had 90-day (25%) and annual (18.2%) readmissions compared to other LAI-a. CONCLUSION Utilization of LAI-a in patients with psychotic disorders can decrease both 90-day and annual psychiatric readmissions by 64% to 65%. Physicians should prefer LAI-a to reduce the readmission rate and improve the quality of life, and decrease the healthcare-related financial burden.
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Kaggwa MM, Najjuka MS, Kesande C, Nyemara N, Kule M, Mamum MA, Bongomin F, Ashaba S. Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver's presence. DISCOVER MENTAL HEALTH 2022; 2:15. [PMID: 37861871 PMCID: PMC10501016 DOI: 10.1007/s44192-022-00018-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/22/2022] [Indexed: 10/21/2023]
Abstract
BACKGROUND Whether the presence of caregivers during the hospital stay of patients with mental illness affects the length of hospital stay (LoS) remains inconclusive. AIMS (1) To determine the average LoS and the associated factors, and (2) to determine the role of caregivers' presences during inpatient stay on LoS. METHODS We conducted a cross-sectional study in two hospitals in Uganda; one with caregivers and the other without caregivers between July to November 2020. Mann-Whitney U test was used to compare LoS in the two selected hospitals and linear regression was used to determine factors associated with LoS. RESULTS A total of 222 participants were enrolled, the majority were males (62.4%). Mean age was 36.3 (standard deviation (SD) = 13.1) years. The average LoS was 18.3 (SD = 22.3) days, with patients in a hospital without caregivers having a longer median LoS (i.e., (30 (interquartile range (IQR) = 30) vs. 7 (7) days; χ2 = 68.95, p < 0.001). The factors significantly associated a longer LoS among our study participants included; being admitted in a hospital without caregivers (adjusted coefficient [aCoef]: 14.88, 95% CI 7.98-21.79, p < 0.001), a diagnosis of schizophrenia (aCoef: 10.68, 95 %CI 5.53-15.83, p < 0.001), being separated or divorced (aCoef: 7.68, 95% CI 1.09-14.27, p = 0.023), and increase in money spent during the admission (aCoef: 0.14, 95% CI 0.09-0.18, p < 0.001). CONCLUSION Patients with mental illness in southwestern Uganda have a short LoS (below 28 days), and the stay was much shorter for patients with fulltime caregivers. We recommend caregivers presence during patient's hospital stay to reduce the LoS and minimize healthcare expenditure.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- African Centre for Suicide Prevention and Research, Mbarara, Uganda.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
| | | | - Claire Kesande
- Butabika National Referral and Teaching Mental Hospital, kampala, Uganda
| | - Novatus Nyemara
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Kule
- Department of Psychiatry, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Mohammed A Mamum
- CHINTA Research Bangladesh, Dhaka, Savar, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Savar, Bangladesh
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Shin J, San Gabriel MCP, Ho-Periola A, Ramer S, Kwon Y, Bang H. The impact of court-ordered psychiatric treatment on hospital length of stay: balancing legal and clinical concerns. JOURNAL OF KOREAN ACADEMY OF PSYCHIATRIC & MENTAL HEALTH NURSING 2022; 31:181-191. [PMID: 35891631 PMCID: PMC9311333 DOI: 10.12934/jkpmhn.2022.31.2.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Psychiatric hospital length of stay (LOS) is not affected solely by socio-clinical factors but also by legal procedures. This study examined the associations between legal procedures and LOS. METHODS Data from 521 patients with psychiatric illnesses hospitalized over 2013-2015 were analyzed. Logistic regression was used to evaluate the predictors of longer (> 14 days) or prolonged (> 30) LOS with socio-clinical factors and legal procedures including court-ordered interventions (assisted outpatient treatment, medication over objection, and retention). RESULTS Longer LOS occurred in 246 patients and 99 had prolonged LOS. Legal procedures affected 57 patients, with 11 assisted outpatient treatments, 39 cases of medication over objection, and 16 retentions. Longer LOS was significantly associated with six factors including older age, unmarried status, non-Hispanic race, risk of violence, schizophrenia, and legal procedures. Legal procedures had the strongest association. Longer/prolonged LOS yielded qualitatively similar associations. CONCLUSION Among 521 psychiatric inpatients, approximately 11% were mandated to receive interventions/procedures by the courts. Court-ordered legal procedures were strongly associated with longer LOS. Mental health providers may consider legal procedures for patients at high treatment/medication noncompliance risk as early as patient admission to inpatient units to prevent, intervene or prepare for a longer or prolonged LOS.
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Affiliation(s)
- Jinah Shin
- Nurse Practitioner, Private Practice, Great Neck, NY, USA
| | - Maria Chona P. San Gabriel
- Attending Psychiatrist, Icahn School of Medicine at Mount Sinai – Health and Hospitals, Elmhurst, NY, USA
| | - Agnes Ho-Periola
- Director of Nursing Informatics, NYC Health and Hospitals, Elmhurst, NY, USA
| | - Sheryl Ramer
- Director of Health Science Library and Development, NYC Health and Hospitals, Elmhurst, NY, USA
| | - Youngihn Kwon
- Data Scientist, Insilicogen, Inc., Yongin-si, Gyeonggi-do, Korea
| | - Heejung Bang
- Professor, Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
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Muchiri S, Azadeh-Fard N, Pakdil F. The Analysis of Hospital Readmission Rates After the Implementation of Hospital Readmissions Reduction Program. J Patient Saf 2022; 18:237-244. [PMID: 34292263 DOI: 10.1097/pts.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aims to analyze the impact of Hospital Readmissions Reduction Program (HRRP) on the nationwide optimization efforts of length of stay (LOS) and readmissions in the United States. METHODS We use the Nationwide Readmission Database between 2010 and 2016 provided in the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality. The study focuses on acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure (CHF), pneumonia monitored by the HRRP and 2 conditions, septicemia, and mood disorders that were not monitored by the HRRP but had among the highest readmissions. Patient demographics and readmissions were analyzed based on insurance type, LOS, and Charlson Comorbidity Index. RESULTS The readmissions vary by conditions, LOS, and insurance types. Congestive heart failure has the highest readmissions among the 6 analyzed conditions at approximately 25%. The readmission rate of CHF rises to 30% for the Medicaid patients and varies between 30% and 35% by LOS. Patients with CHF with higher Charlson Comorbidity Index demonstrates the highest readmissions among 6 conditions. The patients with longer LOSs had higher readmissions, and Medicare patients have a higher reduction in readmissions in acute myocardial infarction and mood disorders compared with the other forms of payments. CONCLUSIONS Our figures show that targeted programs, such as HRRP, may have a positive impact on readmission rates. We, however, observe some graphical evidence that nontargeted conditions could exhibit similar trends. Because of heterogeneity in hospital and patient characteristics, it is pivotal for researcher to consider them in formal analyses.
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Affiliation(s)
- Steve Muchiri
- From the Eastern Connecticut State University, Willimantic, Connecticut
| | - Nasibeh Azadeh-Fard
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, New York
| | - Fatma Pakdil
- From the Eastern Connecticut State University, Willimantic, Connecticut
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21
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Yi Y, Huang Y, Chen Q, Yang H, Li H, Feng Y, Feng S, Zhou S, Li Z, Wu F. Violence, neurocognitive function and clinical correlates in patients with schizophrenia. Front Psychiatry 2022; 13:1087372. [PMID: 36741559 PMCID: PMC9893505 DOI: 10.3389/fpsyt.2022.1087372] [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] [Received: 11/02/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Schizophrenia patients with violent behavior are a severe public health concern, but the correlates of this violent behavior are unknown. Additionally, the relationship between neurocognitive function and violent behavior in Chinese patients with schizophrenia has not yet been investigated. METHODS A total of 337 schizophrenia inpatients were recruited. The Positive and Negative Syndrome Scale (PANSS) was used to assess psychopathological symptoms. Neurocognitive functioning was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS The percentage of violent behavior was 10.4% in patients with schizophrenia. Patients with violent behavior had higher PANSS-positive, excited, and total subscale scores than patients who did not show violent behavior. Patients with violent behavior also had lower RBANS language, semantic fluency, and total subscale scores. Gender (OR = 0.066∼0.819, p = 0.023), illness duration (OR = 0.876∼0.971, p = 0.002), smoking (OR = 1.127∼2.950, p = 0.014), the PANSS positive subscale (OR = 1.050∼1.197, p = 0.001), and the RBANS language subscale (OR = 0.927∼0.987, p = 0.005) significantly contributed to the development of violent behavior in schizophrenia patients. CONCLUSION Our findings revealed that cognitive and clinical assessments should be considered in comprehensive assessments of future risks of violence in schizophrenia patients.
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Affiliation(s)
- Yun Yi
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Chen
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Hanlun Yang
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangdong Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shixuan Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sumiao Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
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22
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Pan YZ, Xie XM, Tang YL, Ng CH, Wang G, Xiang YT. A comparison of aggression between patients with acute schizophrenia and mania presenting to psychiatric emergency services. J Affect Disord 2022; 296:493-497. [PMID: 34653702 DOI: 10.1016/j.jad.2021.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Aggression is common and challenging in psychiatric emergency departments (PED). However, the prevalence of aggression and its correlates in PED patients are not well documented. This study compared the prevalence of aggression between patients with acute schizophrenia and manic episodes. METHODS In this cross-sectional study, patients at a psychiatric emergency department were assessed with measurements of aggression, psychotic and manic symptoms. RESULTS A total of 4,172 patients were included. The prevalence of aggression was 54.8% (95%CI=53.3%-65.2%) in the whole sample, with 48.0% (95%CI=45.8%-50.1%) in patients with an acute schizophrenia episode, and 61.8% (95%CI=59.8%-63.9%) in patients with a manic episode. Multiple logistic regression analysis revealed that, within the acute schizophrenia episode group, male gender (OR=1.47, P<0.01), involuntary admission (OR=3.61, P<0.01) and more severe manic symptoms (OR=1.30, P<0.01) were significantly associated with aggression. Within the manic episode group, living in Beijing (OR=1.51, P<0.01), unemployment (OR=1.34, P=0.03), involuntary admission (OR=7.93, P<0.01), lower education (OR=0.95, P=0.01) and more severe psychotic symptoms (OR=1.05, P<0.01) were significantly associated with aggression. CONCLUSION In this study, aggression appeared to be more common among patients with a manic episode than those with an acute schizophrenia episode. Considering the significant risk of aggression on psychiatric emergency care, appropriate and effective management of aggression in this population group need to be developed.
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Affiliation(s)
- Yi-Zhu Pan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiao-Meng Xie
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, USA
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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23
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Ziltener T, Möller J, Imfeld L, Lieb R, Lang UE, Huber CG. Time to readmission in psychiatric inpatients with a therapeutic leave. J Psychiatr Res 2021; 144:102-109. [PMID: 34610513 DOI: 10.1016/j.jpsychires.2021.09.050] [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] [Received: 05/21/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 01/25/2023]
Abstract
AIMS Interventions to decrease readmissions in psychiatric patients are urgently needed. In Switzerland therapeutic leave (TL) composes a cornerstone of inpatient treatment. TL is a planned time-limited absence from the inpatient ward giving patients the opportunity to test their resilience in their usual environment. Evidence of its applicability as an intervention reducing readmissions is lacking. Therefore, our objective was to examine the association between TL and readmission risk. METHODS Using the Kaplan-Meier curve we compared the time to readmission of 3'302 inpatients at the UPK Basel with and without TL. Cox regression was applied, integrating other covariates associated with readmission. RESULTS The Kaplan-Meier curve indicated longer cumulative survival in patients with TL. The log-rank test implied statistical significance (χ2(1) = 18.8, p < .05). The Cox regression showed a reduced hazard for patients with TL (HR = 0.735, CI 95% = [0.639, 0.846], p < .001) and for involuntarily hospitalized patients (HR = 0.760, CI 95% = [0.618, 0.934], p < .01). A higher readmission risk was found for a history of psychiatric admissions (HR = 1.005, CI 95% = [1.004, 1.005], p < .001), higher severity of symptoms at admission (HR = 1.029, CI 95% = [1.018, 1.040], p < .001), comorbidity (HR = 1.178, CI 95% [1.024, 1.355], p = .022), and a diagnosis with schizophrenia-spectrum disorders (HR = 1.401, CI 95% [1.164, 1.687], p = .001). CONCLUSION Linking TL with readmission risk, our results imply an easy way to improve quality of care, with possible implications for practice, policies and quality interventions. TL might be suitable to enhance recovery, reduce readmissions and health care costs. RCTs are needed for validation.
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Affiliation(s)
- Tiziana Ziltener
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland; University of Basel, Faculty of Psychology, Department of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH, 4055, Basel, Switzerland.
| | - Julian Möller
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland; University of Basel, Faculty of Psychology, Department of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH, 4055, Basel, Switzerland
| | - Lukas Imfeld
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland
| | - Roselind Lieb
- University of Basel, Faculty of Psychology, Department of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH, 4055, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland
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24
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Bulut NS, Yorguner N, Çarkaxhiu Bulut G. The severity of inflammation in major neuropsychiatric disorders: comparison of neutrophil-lymphocyte and platelet-lymphocyte ratios between schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and obsessive compulsive disorder. Nord J Psychiatry 2021; 75:624-632. [PMID: 34319861 DOI: 10.1080/08039488.2021.1919201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As non-specific markers of immune dysregulation, neutrophil-lymphocyte and platelet-lymphocyte ratios (NLR and PLR) have been consistently shown to be increased in major neuropsychiatric disorders. Although this increase seems to be trans-diagnostic, the extent to which its magnitude differs between disorders remains largely unclear. AIM The aim of this study was to directly compare the severity of inflammation (as reflected by NLR and PLR) between schizophrenia (Sch), bipolar mania (BD-M), bipolar depression (BD-D), major depressive disorder (MDD) and obsessive compulsive disorder (OCD). METHODS NLR and PLR were obtained for a total of 417 subjects (91 Sch, 70 BD-D, 37 BD-M, 93 MDD, 37 OCD, and 95 controls) and analyzed for group differences. RESULTS Sch, BD-M, BD-D and MDD presented with significantly higher NLR compared with both OCD and HC. NLR in BD-M was significantly higher than all the remaining groups, whereas Sch, BD-D and MDD presented with comparably elevated NLR. Moreover, BD-M, Sch and MDD had significantly higher PLR compared with HC. CONCLUSION These results suggest that the underlying inflammation may be most severe in BD-M, followed by Sch, BD-D and MDD. On the other hand, inflammation may be of negligible intensity in OCD, or at least undetectable by means of NLR or PLR.
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Affiliation(s)
- Necati Serkut Bulut
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Neşe Yorguner
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Gresa Çarkaxhiu Bulut
- Department of Child and Adolescent Psychiatry, Maltepe University Medical School, Istanbul, Turkey
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25
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Daley A, Scobie B, Shorey J, Breece J, Oxley S. Predicting 30-Day Readmissions: Evidence From a Small Rural Psychiatric Hospital. J Psychiatr Pract 2021; 27:346-360. [PMID: 34529601 DOI: 10.1097/pra.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To improve quality of care and patient outcomes, and to reduce costs, hospitals in the United States are trying to mitigate readmissions that are potentially avoidable. By identifying high-risk patients, hospitals may be able to proactively adapt treatment and discharge planning to reduce the likelihood of readmission. Our objective in this study was to derive and validate a predictive model of 30-day readmissions for a small rural psychiatric hospital in the northeast. However, this model can be adapted by other rural psychiatric hospitals-a context that has been understudied in the literature. Our sample consisted of 1912 adult inpatients (1281 in the derivation cohort and 631 in the validation cohort), who were admitted between August 1, 2014, and July 31, 2016. We used deidentified data from the hospital's electronic medical record, including physician orders and discharge summaries. These data were merged with community-level variables that reflected the availability of care in the patients' zip codes. We first considered the correlates of 30-day readmission in a regression framework. We found that the probability of readmission increased with the number of previous admissions (vs. no readmissions). Moreover, the probability of readmission was much higher for patients with a depressive disorder (vs. no depressive disorder), with another mood disorder (vs. no other mood disorder), and/or with a psychotic disorder (vs. no psychotic disorder). We used these associations to derive a predictive model, in which we used the regression coefficients to construct a score for each patient. We then estimated the predicted probability of 30-day readmission on the basis of that score. After validating the model, we discuss the implications for clinical practice and the limitations of our approach.
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26
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Gobbicchi C, Verdolini N, Menculini G, Cirimbilli F, Gallucci D, Vieta E, Tortorella A. Searching for factors associated with the "Revolving Door phenomenon" in the psychiatric inpatient unit: A 5-year retrospective cohort study. Psychiatry Res 2021; 303:114080. [PMID: 34246004 DOI: 10.1016/j.psychres.2021.114080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
The revolving door (RD) phenomenon refers to subjects who undergo frequent rehospitalizations in psychiatric units. The main aim of this study was to analyze clinical factors associated with RD in acute inpatient psychiatric ward. In a 5-year cohort study, subjects hospitalized three or more times in 12 months (revolving door subjects-RDS) were identified. A total of 1,324 subjects were hospitalized. RDS represented 6.3% (n = 84) of the entire sample with a total of 337 RD hospitalizations (revolving door hospitalizations-RDH) (16.7% of all admissions). RDS were younger, unmarried, with comorbid substance related disorders, with mood or psychotic disorders and affected by comorbid medical conditions. After controlling for age, sex and marital status, the most strongly associated variable with RDH was the comorbidity between mood and substance use disorders. Other associated factors were the presence of a comorbid medical condition and a longer length of stay. The commitment to community residential facilities and the treatment with a first generation long-acting antipsychotic were also associated with RDH. On the contrary, admissions to the psychiatric unit for manic/hypomanic episode or for self-directed harmful behavior were inversely associated with RDH. Attention should be given to these clinical variables in order to reduce RD.
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Affiliation(s)
- Chiara Gobbicchi
- Department of Psychiatry, University of Perugia, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy; Department of Mental Health, AUSL Umbria 2, Terni, Viale D. Bramante 37, 05100 Terni (TR) Italy
| | - Norma Verdolini
- Department of Psychiatry, University of Perugia, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - Federica Cirimbilli
- Department of Psychiatry, University of Perugia, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - Daniela Gallucci
- Department of Psychiatry, University of Perugia, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy; AUSL Umbria 1, Via G. Guerra, Perugia, 21 Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy.
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27
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Chan F, O'Gorman C, Swayne A, Gillis D, Blum S, Warren N. Voltage-gated potassium channel blanket testing in first-episode psychosis: Diagnostic nihilism? Aust N Z J Psychiatry 2021; 55:817-823. [PMID: 33423505 DOI: 10.1177/0004867420983454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Voltage-gated potassium channel antibodies are implicated in limbic encephalitis and currently included in first-episode psychosis organic screening guidelines. Individuals with high-positive voltage-gated potassium channel titres most commonly present with neurological symptoms as well as sleep, cognitive, behaviour, psychosis and mood disturbance. The significance of low-positive voltage-gated potassium channel antibody titres in psychiatric patients is unclear and has not been previously examined. We aim to describe a statewide cohort of psychiatric patients with low- and high-positive voltage-gated potassium channel titres and explore if this finding influenced clinical management and patient outcomes. METHODS A retrospective review of all voltage-gated potassium channel antibodies testing performed in public psychiatric services in Queensland, Australia, with comparison of the clinical presentation and long-term outcomes of low- and high-positive voltage-gated potassium channel titre cases. Specific antigen targets (leucine-rich glioma-inactivated protein 1 and contactin-associated protein 2 antibodies) were also assessed. RESULTS The overall prevalence of voltage-gated potassium channel antibody positivity in Queensland, public, psychiatric service testing was 0.3% (14/4098), with 12 cases of low-positive voltage-gated potassium channel titre, 2 cases of high-positive (leucine-rich glioma-inactivated protein 1 antibody positive) cases and a voltage-gated potassium channel negative contactin-associated protein 2 antibody positive case. No low-positive case developed neurological abnormalities or had abnormal paraclinical investigations. In comparison, both high-positive voltage-gated potassium channel/leucine-rich glioma-inactivated protein 1 cases and the contactin-associated protein 2 antibody positive case rapidly developed neurological symptoms, had abnormal paraclinical testing and improved only with immunotherapy. There was no later development of encephalitic symptoms in the low-positive cases over an average of 1067 days follow-up. CONCLUSION Voltage-gated potassium channel antibody-associated limbic encephalitis was rare, and always associated with high antibody titres. Low-positive titres were not associated with the development of encephalitis over a long period of follow-up. The value of universal voltage-gated potassium channel antibody screening is unclear, and further prospective studies in first-episode psychosis populations are required.
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Affiliation(s)
- Fiona Chan
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Cullen O'Gorman
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Mater Centre for Neurosciences, Mater Hospital Brisbane, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew Swayne
- Mater Centre for Neurosciences, Mater Hospital Brisbane, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - David Gillis
- Queensland Pathology, Brisbane, QLD, Australia.,Immunology Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Mater Centre for Neurosciences, Mater Hospital Brisbane, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nicola Warren
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro South Addiction and Mental Health, Princess Alexandra Hospital, Brisbane, QLD, Australia
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28
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Dawoodbhoy FM, Delaney J, Cecula P, Yu J, Peacock I, Tan J, Cox B. AI in patient flow: applications of artificial intelligence to improve patient flow in NHS acute mental health inpatient units. Heliyon 2021; 7:e06993. [PMID: 34036191 PMCID: PMC8134991 DOI: 10.1016/j.heliyon.2021.e06993] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Growing demand for mental health services, coupled with funding and resource limitations, creates an opportunity for novel technological solutions including artificial intelligence (AI). This study aims to identify issues in patient flow on mental health units and align them with potential AI solutions, ultimately devising a model for their integration at service level. Method Following a narrative literature review and pilot interview, 20 semi-structured interviews were conducted with AI and mental health experts. Thematic analysis was then used to analyse and synthesise gathered data and construct an enhanced model. Results Predictive variables for length-of-stay and readmission rate are not consistent in the literature. There are, however, common themes in patient flow issues. An analysis identified several potential areas for AI-enhanced patient flow. Firstly, AI could improve patient flow by streamlining administrative tasks and optimising allocation of resources. Secondly, real-time data analytics systems could support clinician decision-making in triage, discharge, diagnosis and treatment stages. Finally, longer-term, development of solutions such as digital phenotyping could help transform mental health care to a more preventative, personalised model. Conclusions Recommendations were formulated for NHS trusts open to adopting AI patient flow enhancements. Although AI offers many promising use-cases, greater collaborative investment and infrastructure are needed to deliver clinically validated improvements. Concerns around data-use, regulation and transparency remain, and hospitals must continue to balance guidelines with stakeholder priorities. Further research is needed to connect existing case studies and develop a framework for their evaluation.
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Affiliation(s)
- Fatema Mustansir Dawoodbhoy
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jack Delaney
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Paulina Cecula
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jiakun Yu
- Imperial College London Business School, London, UK.,Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Iain Peacock
- Imperial College London Business School, London, UK.,Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Joseph Tan
- Imperial College London Business School, London, UK.,Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Benita Cox
- Imperial College London Business School, London, UK
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29
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Durns TA, O'Connell PH, Shvartsur A, Grey JS, Kious BM. Effects of temporary psychiatric holds on length of stay and readmission risk among persons admitted for psychotic disorders. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 76:101695. [PMID: 33761439 DOI: 10.1016/j.ijlp.2021.101695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
The practice of involuntary psychiatric commitment is central to the acute treatment of persons with severe mental illness and others in psychiatric crisis. Deciding whether a patient should be admitted involuntarily requires weighing respect for autonomy against beneficence, considering the clinical needs of the patient, and navigating ambiguous legal standards. The relative dearth of information about the impact of involuntary commitment on objective patient outcomes complicates matters ethically, legally, and clinically. To address this gap in the literature, we sought to determine the association between temporary psychiatric holds and length of stay and readmission rates among a retrospective sample of adult patients admitted to a large psychiatric hospital with diagnoses of schizophrenia, schizoaffective disorder, mania, and other psychotic disorders. In total, we identified 460 patients and 559 unique encounters meeting our inclusion criteria; 90 of the encounters were voluntary (involving a temporary psychiatric hold) and 469 were involuntary. Univariable and multivariable analyses suggested that temporary psychiatric holds were not significantly associated with either length of stay or readmission rate. These findings are relevant to clinicians who must decide whether to admit a patient involuntarily, as they suggest that making a patient involuntary is not associated with differences in length of stay or readmission risk.
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Affiliation(s)
- Tyler A Durns
- Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Patrick H O'Connell
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Anna Shvartsur
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Jessica S Grey
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Brent M Kious
- Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA.
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30
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Dey S, Mellsop G, Obertova Z, Jenkins M. Sociodemographic and clinical variables associated with discharge under compulsory treatment orders. Australas Psychiatry 2021; 29:163-168. [PMID: 33354991 DOI: 10.1177/1039856220970054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To document the sociodemographic and clinical variables associated with discharge under compulsory treatment orders in patients with schizophrenia or related disorders. METHOD Information on various sociodemographic and clinical variables were extracted from the clinical files of 349 patients discharged from an adult (age 18-65) inpatient psychiatric unit with diagnoses of schizophrenia or related disorders. Univariate and multiple logistic regression analyses with legal compulsion (compulsory versus voluntary) as outcomes were applied. RESULTS Two hundred of the 349 discharged patients were placed under compulsory treatment orders. In the univariate logistic regression analysis, unemployment, diagnosis of schizophrenia, forensic history, dosage of antipsychotics, prescription and frequency of injectable antipsychotics, polypharmacy and a hospital stay of more than 28 days were associated with compulsory status. Being married or in partnership and living with partner was associated with voluntary status. Multiple regression models respectively confirmed most of these relationships observed in the univariate analyses. CONCLUSION Clarification of the apparent drivers for compulsory treatment may help thoughtful reductions in the use of compulsion.
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Affiliation(s)
| | | | - Zuzana Obertova
- Centre for Forensic Anthropology, University of Western Australia, Crawley, WA, Australia
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Hope J, Keks NA, Pring W, Adamopoulos V, Toffler D, Macfarlane S, Van Sebille D. Comparison of inpatients who were readmitted within 28 days of discharge with those not readmitted: an audit at an Australian private psychiatric hospital. Australas Psychiatry 2021; 29:169-174. [PMID: 33434049 DOI: 10.1177/1039856220984049] [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: 11/16/2022]
Abstract
OBJECTIVE To compare inpatients who had been readmitted within 28 days of discharge with patients not readmitted within the same period in a private psychiatric hospital. METHOD Of 118 readmissions within 28 days in 2017 (7% of admissions), 50 were randomly selected and matched by age and gender with control patients who had not been readmitted within 28 days. Differences in demographics, diagnosis, length of stay and number of admissions in the previous 12 months were examined. RESULTS Readmitted cases were 64% female, were aged 49.8 ± 18.2 years (range 19-89), 40% were in relationships and 24% were receiving disability support. Most patients were suffering an episode of depression. Cases had higher rates of multiple psychiatric diagnoses (p < .001) and physical disorders (p < .05). There were no significant differences between cases and controls on psychiatric diagnoses. Cases had a longer length of stay in their previous admission (p < .01) and a higher number of admissions in the preceding 12 months (p < .05) compared to controls. CONCLUSION This study indicates that inpatients readmitted within 28 days of discharge were more likely to have multiple diagnoses, physical co-morbidity and relapsing conditions than patients who were not readmitted.
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Affiliation(s)
- Judith Hope
- Eastern Health Clinical School, Monash University, VIC, Australia.,Centre of Mental Health Education and Research, Delmont Private Hospital, VIC, Australia
| | - Nicholas A Keks
- Monash University, VIC, Australia.,Centre of Mental Health Education and Research, Delmont Private Hospital, VIC, Australia.,Monash Medical Centre, VIC, Australia
| | - William Pring
- Monash University, VIC, Australia.,Centre of Mental Health Education and Research, Delmont Private Hospital, VIC, Australia
| | - Voula Adamopoulos
- Centre of Mental Health Education and Research, Delmont Private Hospital, VIC, Australia
| | - David Toffler
- Centre of Mental Health Education and Research, Delmont Private Hospital, VIC, Australia
| | - Stephen Macfarlane
- Monash University VIC, Australia.,Delmont Private Hospital, VIC, Australia
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Rosenberg S, Harvey C. Mental Health in Australia and the Challenge of Community Mental Health Reform. CONSORTIUM PSYCHIATRICUM 2021; 2:40-46. [PMID: 38601099 PMCID: PMC11003349 DOI: 10.17816/cp44] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/02/2021] [Indexed: 11/08/2022] Open
Abstract
Australia was one of the first countries to develop and implement a national mental health plan, 30 years ago. This national approach belied the countrys federal structure, in which the federal government takes responsibility for primary care while state and territory governments manage acute and hospital mental health care. This arrangement has led to significant variations across jurisdictions. It has also left secondary care, often provided in the community, outside of this governance arrangement. This article explores this dilemma and its implications for community mental health, and suggests key steps towards more effective reform of this vital element of mental health care.
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Orooji A, Nazar E, Sadeghi M, Moradi A, Jafari Z, Esmaily H. Factors associated with length of stay in hospital among the elderly patients using count regression models. Med J Islam Repub Iran 2021; 35:5. [PMID: 33996656 PMCID: PMC8111647 DOI: 10.47176/mjiri.35.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Indexed: 11/09/2022] Open
Abstract
Background: Aging is a major challenge not only for high-income countries but also for middle- and low-income countries. The length of stay (LOS) in hospitals is one of the major concerns of elderly patients, which should be taken into consideration. We aimed to investigate the factors affecting LOS of elderly patients admitted to a referral hospital of northeast of Iran.
Methods: A relatively large population of 7130 hospitalized elderly patients (over 65 years old) who referred to Ghaem hospital (Mashhad, Iran) from March 20, 2016 to March 19, 2017 were selected. The demographic and medical records data of patients were extracted from the hospital database. Univariate analyses as well as count regression models, including poisson regression and negative binomial regression, were conducted to assess the influential factors on the LOS and the number of admissions considered for potential confounders using SAS software. In this study α =0.05 was considered as statistically significant.
Results: The mean age of participants was 76.57±7.29 years, and 54.8% were male and 45.2% were female. The mean LOS was 8.11±13.97 days and the mean number of admissions 1.5±1.73 times. The negative binomial regression model had better fitness than Poisson's model. Findings indicated that emergency hospitalization (RR: 0.21), admission to the CCU (RR: 0.33), and male gender (RR: 0.92) were statistically reducing factors for LOS among elderly patients, respectively. Discharge status (deceased, RR: 1.50), patients with diagnosis of injuries and poisoning (RR: 1.34), and native residence (RR: 1.10) were factors that statistically increased the length of stay among hospitalized elderly patients.
Conclusion: LOS in hospitals is affected by multiple factors and the negative binomial regression model is a better statistical method for estimating the influencing factors.
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Affiliation(s)
- Arezoo Orooji
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eisa Nazar
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sadeghi
- Department of Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Jafari
- Clinical Research development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Miller DAA, Ronis ST, Slaunwhite AK. The Impact of Demographic, Clinical, and Institutional Factors on Psychiatric Inpatient Length-of-Stay. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:683-694. [PMID: 33386529 DOI: 10.1007/s10488-020-01104-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/14/2023]
Abstract
The average length of inpatient stay (LOS) for psychiatric care has declined substantially across Canada and the United States during the past two decades. Although LOS is based presumably on patient, hospital, and community factors, there is little understanding of how such factors are linked with LOS. The purpose of this study was to explore potential individual and systemic factors associated with LOS in a large-scale, longitudinal dataset. Study participants consisted of individuals 11 years of age and older admitted for psychiatric conditions to a New Brunswick hospital between April 1, 2003 and March 31, 2014 (N = 51,865). The study used a retrospective cohort design examining data from the New Brunswick Discharge Abstract Database, administrative data comprised of all inpatient admissions across provincial hospitals. Hierarchical regression analysis was used to estimate the association of individual, facility, and system-level factors with psychiatric LOS. Results indicated that hospital-level factors and individual-level characteristics (i.e., discharge disposition, aftercare referral, socioeconomic status (SES)) account for significant variability in LOS. Consistent with extant literature, our results found that hospital, clinical, and individual factors together are associated with LOS. Furthermore, our results highlight demographic factors surrounding living situation and available financial supports, as well as the match or mismatch between preferred language and language in which services are offered.
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Affiliation(s)
- David A A Miller
- Department of Psychology, University of New Brunswick, 38 Dineen Dr, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada
| | - Scott T Ronis
- Department of Psychology, University of New Brunswick, 38 Dineen Dr, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada.
| | - Amanda K Slaunwhite
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
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Penzenstadler L, Chatton A, Thorens G, Zullino D, Khazaal Y. Factors influencing the length of hospital stay of patients with substance use disorders. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2020.1766130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Anne Chatton
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Gabriel Thorens
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Daniele Zullino
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospitals and Lausanne University, Lausanne, Switzerland
- Research Center, Montreal University Institute of Mental Health, Montreal, Canada
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Kinoshita H, Kuroki N, Okada T. Violent Behavior Prior to Admission Is Not a Factor in Further Prolonged Length of Stay: A Retrospective Cohort Study in a Japanese Psychiatric Hospital. Front Psychiatry 2021; 12:600456. [PMID: 34290626 PMCID: PMC8287124 DOI: 10.3389/fpsyt.2021.600456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background: This study assessed the hypothesis that violent behavior prior to admission prolongs psychiatric hospitalization and evaluated the likelihood of hospital discharge to a community care setting based on demographic and clinical factors, with an emphasis on violent behavior. Methods: We retrospectively selected 362 patients who were involuntarily admitted to a psychiatric hospital in Japan from December 1, 2015 to November 30, 2017, stayed longer than planned, and underwent review by a multidisciplinary team. We assessed (a) education and marital status and history of substance abuse, (b) the presence/absence and type of violent behavior that led to hospital admission, and (c) the discharge criteria. We divided the subjects into groups according to whether they had demonstrated violent behavior prior to admission and compared demographic and clinical variables between the groups using bivariate analysis. We also analyzed data using the Cox proportional hazard model, defining discharge to the community as the outcome. Age, sex, and variables that were significant at a level of P < 0.05 based on Cox univariate analysis were included in the multivariate models using the forced entry method. Results: The Violent group included 94 patients (26%). There were no significant between-group differences in age, sex, educational background, marital history, career history, or the history of substance abuse. However, hospitalization was significantly longer in the Non-violent group. The Cox proportional multivariate hazard ratios revealed that violent behavior prior to admission resulted in a higher probability of hospital discharge. Conclusion: Violent behavior prior to admission did not significantly contribute to prolonged hospitalization in patients who deviated from the treatment plan and had exceeded the planned hospitalization duration. Our findings recommend caution when using violence and impulsiveness observed during the acute stage to predict the difficulty of long-term treatment.
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Affiliation(s)
- Hidetoshi Kinoshita
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.,Forensic Mental Health Unit, Department of Psychiatry and Behavioral Sciences, Division of Cognitive and Behavioral Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriomi Kuroki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Takayuki Okada
- Forensic Mental Health Unit, Department of Psychiatry and Behavioral Sciences, Division of Cognitive and Behavioral Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Miller DAA, Ronis ST, Slaunwhite AK, Audas R, Richard J, Tilleczek K, Zhang M. Longitudinal examination of youth readmission to mental health inpatient units. Child Adolesc Ment Health 2020; 25:238-248. [PMID: 32516481 DOI: 10.1111/camh.12371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Significant barriers exist for youth in obtaining mental health services. These barriers are exacerbated by growing demand, attributed partially to children and adolescents who have repeat hospital admissions. The purpose of this study was to identify demographic, socioeconomic and clinical predictors of readmission to inpatient psychiatric services in New Brunswick, Canada. METHOD Key demographic, support and clinical predictors of readmission were identified. The New Brunswick Discharge Abstract Database (DAD) was used to compile a cohort of all children and adolescents ages 3-19 years with psychiatric hospital admissions between 1 April 2003 and 31 March 2014 (N = 3825). Primary analyses consisted of Kaplan-Meier survival methods with log-rank tests to assess time-to-readmission variability, and Cox regression to identify significant predictors of readmission. RESULTS In total, 27.8% of admitted children and adolescents experienced at least one readmission within the 10-year period, with 57.3% readmitted to hospital within 90 days following discharge. Bivariate results indicated that male, upper-middle socioeconomic status (SES) youths aged 11-15 years from nonrural communities were most likely to be readmitted. Notable predictors of increased readmission likelihood were older age, being male, higher SES, referral to care by medical practitioner, discharge to another health facility, psychosis, and previous psychiatric admission. CONCLUSION A significant portion of the variance in readmission was accounted for by youth demographic characteristics (i.e. age, SES, geographic location) and various support structures, including referrals to inpatient care and aftercare support services. KEY PRACTITIONER MESSAGE Readmission to inpatient psychiatric care among youth is affected by a number of multifaceted risk factors across individual, environmental and clinical domains. This study used provincial population-scale longitudinal administrative data to demonstrate the influence of various individual and demographic factors on likelihood of readmission, which is notably absent from the majority of studies that make use of smaller, short-term data samples. Ensuring that multiple factors outside of the clinical context are considered when examining readmission among youth may contribute to a more thorough understanding of youth hospitalization patterns.
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Affiliation(s)
- David A A Miller
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Scott T Ronis
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Amanda K Slaunwhite
- BC Centre for Disease Control, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rick Audas
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jacques Richard
- École de Psychologie, Université de Moncton, Moncton, NB, Canada
| | - Kate Tilleczek
- Faculty of Education, York University, Toronto, ON, Canada
| | - Michael Zhang
- Sobey School of Business, Saint Mary's University, Halifax, NS, Canada
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38
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Silva M, Antunes A, Loureiro A, Azeredo-Lopes S, Saraceno B, Caldas-de-Almeida JM, Cardoso G. Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal. Psychiatry Res 2020; 293:113420. [PMID: 32861099 DOI: 10.1016/j.psychres.2020.113420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
Assessing the factors that influence duration and number of hospitalizations may support mental health services planning and delivery. This study examines the factors associated with length of stay and readmission in Portuguese psychiatric inpatient services during 2002, 2007 and 2012. Data from all admissions were extracted from clinical files. Logistic regression models estimated the association between length of stay (<17 vs ≥17 days) and number of admissions per year (1 vs >1 admission) with sociodemographic, clinical, and contextual factors. Older age, a diagnosis of psychosis, and compulsory admission were associated with higher odds of longer length of stay. Being married, secondary education, suicide attempt, a diagnosis of substance use and "other mental disorders", being admitted in 2012, and two of the psychiatric inpatient services associated with lower odds of longer length of stay. Being retired (or others), a diagnosis of psychosis, compulsory admission, and psychiatric service were associated with increased odds of readmission. Older age, and secondary and higher education were associated with lower odds of readmission. The findings indicate that multiple factors influence length of stay and readmission. Identifying these factors provides useful evidence for clinicians and policy makers to design more targeted and cost-effective interventions.
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Affiliation(s)
- M Silva
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal.
| | - A Antunes
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal.
| | - A Loureiro
- Centre of Studies on Geography and Spatial Planning (CEGOT), Faculty of Arts and Humanities, Coimbra, Portugal
| | - S Azeredo-Lopes
- Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.
| | - B Saraceno
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - J M Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - G Cardoso
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
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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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Haddad C, Sacre H, Hallit S, Obeid S, Al-Zein D, Nabout R, Zoghbi M, Haddad G. Prevalence of comorbidities and correlates of hospital readmission rate in patients with acute mania: A one-year retrospective data from a tertiary care. Perspect Psychiatr Care 2020; 56:753-759. [PMID: 31828814 DOI: 10.1111/ppc.12464] [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] [Received: 07/01/2019] [Revised: 11/24/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the prevalence of medical comorbidities in acute manic patients over a period of 1 year, and to evaluate correlates of the readmission rate. DESIGN/METHODS A retrospective observational study was conducted on 158 acute manic patients from 2016 to 2017. RESULTS The most common physical comorbidity was obesity (36.1%) followed by cardiovascular disorders (15.2%) and liver dysfunctions (9.3%). Male gender was associated with higher readmission rate (Beta = -0.260), while taking anticholinergic drugs (Beta = -0.338) and having a family history of psychiatric disorders (Beta = -0.222) were associated with lower readmission rate. PRACTICAL IMPLICATIONS The study results may help physicians and other clinicians understand the burden of illness recurrence in bipolar disorder type I patients and adopt effective strategies to prevent relapse, taking into account all comorbidities.
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Affiliation(s)
- Chadia Haddad
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medicine Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sahar Obeid
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Department of Psychology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Darine Al-Zein
- Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
| | - Rita Nabout
- Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Department of Family Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Haddad
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine and Medicine Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
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Sharker S, Balbuena L, Marcoux G, Feng CX. Modeling socio-demographic and clinical factors influencing psychiatric inpatient service use: a comparison of models for zero-Inflated and overdispersed count data. BMC Med Res Methodol 2020; 20:232. [PMID: 32938381 PMCID: PMC7495888 DOI: 10.1186/s12874-020-01112-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric disorders may occur as a single episode or be persistent and relapsing, sometimes leading to suicidal behaviours. The exact causes of psychiatric disorders are hard to determine but easy access to health care services can help to reduce their severity. The aim of this study was to investigate the factors associated with repeated hospitalizations among the patients with psychiatric illness, which may help the policy makers to target the high-risk groups in a more focused manner. METHODS A large linked administrative database consisting of 200,537 patients with psychiatric diagnosis in the years of 2008-2012 was used in this analysis. Various counts regression models including zero-inflated and hurdle models were considered for analyzing the hospitalization rate among patients with psychiatric disorders within three months follow-up since their index visit dates. The covariates for this study consisted of socio-demographic and clinical characteristics of the patients. RESULTS The results show that the odds of hospitalization are significantly higher among registered Indians, male patients and younger patients. Hospitalization rate depends on the patients' disease types. Having previously visited a general physician served a protective role for psychiatric hospitalization during the study period. Patients who had seen an outpatient psychiatrist were more likely to have a higher number of psychiatric hospitalizations. This may indicate that psychiatrists tend to see patients with more severe illnesses, who require hospital-based care for managing their illness. CONCLUSIONS Providing easier access to registered Indian people and youth may reduce the need for hospital-based care. Patients with mental health conditions may benefit from greater and more timely access to primary care.
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Affiliation(s)
- Sharmin Sharker
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Canada
| | - Lloyd Balbuena
- Department of Psychiatry, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, S7N 0W8, Canada
| | - Gene Marcoux
- Department of Psychiatry, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, S7N 0W8, Canada
| | - Cindy Xin Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Canada. .,Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, B3H 1V7, Canada.
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Patient and service-level factors affecting length of inpatient stay in an acute mental health service: a retrospective case cohort study. BMC Psychiatry 2020; 20:438. [PMID: 32894103 PMCID: PMC7487453 DOI: 10.1186/s12888-020-02846-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/30/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this. Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay. METHODS We conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a 1 month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data. RESULTS Short-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement. The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay. CONCLUSIONS The study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.
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Gholi Zadeh Kharrat F, Shydeo Brandão Miyoshi N, Cobre J, Mazzoncini De Azevedo-Marques J, Mazzoncini de Azevedo-Marques P, Cláudio Botazzo Delbem A. Feature sensitivity criterion-based sampling strategy from the Optimization based on Phylogram Analysis (Fs-OPA) and Cox regression applied to mental disorder datasets. PLoS One 2020; 15:e0235147. [PMID: 32609749 PMCID: PMC7329087 DOI: 10.1371/journal.pone.0235147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
Digital datasets in several health care facilities, as hospitals and prehospital services, accumulated data from thousands of patients for more than a decade. In general, there is no local team with enough experts with the required different skills capable of analyzing them in entirety. The integration of those abilities usually demands a relatively long-period and is cost. Considering that scenario, this paper proposes a new Feature Sensitivity technique that can automatically deal with a large dataset. It uses a criterion-based sampling strategy from the Optimization based on Phylogram Analysis. Called FS-opa, the new approach seems proper for dealing with any types of raw data from health centers and manipulate their entire datasets. Besides, FS-opa can find the principal features for the construction of inference models without depending on expert knowledge of the problem domain. The selected features can be combined with usual statistical or machine learning methods to perform predictions. The new method can mine entire datasets from scratch. FS-opa was evaluated using a relatively large dataset from electronic health records of mental disorder prehospital services in Brazil. Cox's approach was integrated to FS-opa to generate survival analysis models related to the length of stay (LOS) in hospitals, assuming that it is a relevant aspect that can benefit estimates of the efficiency of hospitals and the quality of patient treatments. Since FS-opa can work with raw datasets, no knowledge from the problem domain was used to obtain the preliminary prediction models found. Results show that FS-opa succeeded in performing a feature sensitivity analysis using only the raw data available. In this way, FS-opa can find the principal features without bias of an inference model, since the proposed method does not use it. Moreover, the experiments show that FS-opa can provide models with a useful trade-off according to their representativeness and parsimony. It can benefit further analyses by experts since they can focus on aspects that benefit problem modeling.
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Affiliation(s)
- Fatemeh Gholi Zadeh Kharrat
- Department of Bioengineering, Universidade de Sao Paulo Escola de Engenharia de Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Newton Shydeo Brandão Miyoshi
- Center of Information and Informatics of Medical School, Ribeirao Preto, Universidade de Sao Paulo Escola de Enfermagem de Ribeirao Preto, Sao Paulo, Brazil
| | - Juliana Cobre
- Department of Mathematics and Statistics, Universidade de Sao Paulo Instituto de Ciencias Matematicas e de Computacao, Sao Carlos, Sao Paulo, Brazil
| | | | - Paulo Mazzoncini de Azevedo-Marques
- Department of Medical Imaging, Hematology and Clinical Oncology of Medical School, Universidade de Sao Paulo Campus de Ribeirao Preto, Ribeirao Preto, Sao Paulo, Brazil
| | - Alexandre Cláudio Botazzo Delbem
- Department of Bioengineering, Universidade de Sao Paulo Escola de Engenharia de Sao Carlos, Sao Carlos, Sao Paulo, Brazil
- Department of Computer Science, Universidade de Sao Paulo Instituto de Ciencias Matematicas e de Computacao, Sao Carlos, Sao Paulo, Brazil
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Sutherland G, Harvey C, Tibble H, Spittal MJ, Farhall J, Fletcher J, Meadows G, Newton JR, Vine R, Brophy L. Similarities and differences in people accessing prevention and recovery care services and inpatient units in Victoria, Australia. BMC Health Serv Res 2020; 20:542. [PMID: 32546224 PMCID: PMC7296697 DOI: 10.1186/s12913-020-05402-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background There is an emerging international literature demonstrating clinical and cost-effectiveness of sub-acute residential mental health services. To date, however, there is limited information on the profile of consumers accessing these models of care. This study aimed to understand the profile of the population served by adult sub-acute residential mental health services in Victoria, Australia (known as Prevention and Recovery Care; PARC) and to compare PARC service consumers with consumers admitted to psychiatric inpatient units within public hospitals. Method Using 5 years (2012–2016) of a state-wide database of routinely collected individual level mental health service data, we describe the socio-demographic and clinical profile of PARC service consumers compared to consumers of psychiatric inpatient units including for primary diagnosis and illness severity. Using admissions as the unit of analysis, we identify the characteristics that distinguish PARC service admissions from psychiatric inpatient admissions. We also examine and compare length of stay for the different admission types. Results We analysed 78,264 admissions representing 34,906 individuals. The profile of PARC service consumers differed from those admitted to inpatient units including for sex, age, diagnosis and illness severity. The odds of an admission being to a PARC service was associated with several socio-demographic and clinical characteristics. Being male or in the youngest age grouping (< 20 years) significantly reduced the odds of admission to PARC services. The presence of primary diagnoses of schizophrenia and related disorders, mood, anxiety or personality disorders, all significantly increased the odds of admission to PARC services. Predictors of length of stay were consistent across PARC and inpatient admission types. Conclusions Our findings suggest PARC services may serve an overlapping but distinguishably different consumer group than inpatient psychiatric units. Future research on sub-acute mental health services should be cognizant of these consumer differences, particularly when assessing the long-term effectiveness of this service option.
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Affiliation(s)
- Georgina Sutherland
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Holly Tibble
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, VIC, Australia.,NorthWestern Mental Health, Parkville, VIC, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Graham Meadows
- Southern Synergy, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - J Richard Newton
- Dept of Psychiatry, Monash University, Peninsula Mental Health Service, Frankston, VIC, Australia
| | - Ruth Vine
- NorthWestern Mental Health, Parkville, VIC, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,School of Allied Health, Human Services and Sport, La Trobe University , Bundoora, VIC, Australia
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45
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Keks NA, Hope J, Adamopoulos V, Pring W, Tofler D, Macfarlane S, Van Sebille D. Characteristics, diagnoses and risk profiles of inpatients readmitted within 28 days of discharge to an Australian private psychiatric hospital. Australas Psychiatry 2020; 28:311-321. [PMID: 32019356 DOI: 10.1177/1039856220901469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to perform a clinical and risk audit of private hospital inpatients who had been readmitted within 28 days of a preceding admission. METHOD Of 118 readmissions within 28 days in 2017 (7% of all admissions), 50 were randomly selected for audit. Characteristics, illness severity and clinical risk profiles were ascertained at discharge from the index admission and at readmission. RESULTS Cases were 64% female, age 49.9 ± 18.2 years (range 19-89), 40% in relationships and 24% on disability support. At readmission, 88% posed danger to self due to effects of illness, 46% had high suicide risk and 40% had high physical risk. Illness was rated as severe in 58%, while 40% were rated markedly ill. Relapse or exacerbation of major depression was a cause of readmission in 78%, relapse of alcohol/substance use requiring readmission in 22% and relapse of psychosis in 20%. Index admission length of stay of cases did not differ from that of all hospital admissions. CONCLUSION Most readmitted patients were suffering severe exacerbation of depression, were acutely suicidal and were otherwise at high risk of harm. If these patients had been denied readmission on the basis of insurer funding disincentives, catastrophic outcomes may well have occurred.
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Affiliation(s)
- Nicholas A Keks
- Monash University, Australia.,Centre of Mental Health Education and Research at Delmont Private Hospital, Australia.,Monash Medical Centre, Australia
| | - Judith Hope
- Monash University, Australia.,Eastern Health, Australia.,Centre of Mental Health Education and Research at Delmont Private Hospital, Australia
| | - Voula Adamopoulos
- Centre of Mental Health Education and Research at Delmont Private Hospital, Australia
| | - William Pring
- Monash University, Australia.,Centre of Mental Health Education and Research at Delmont Private Hospital, Australia
| | - David Tofler
- Centre of Mental Health Education and Research at Delmont Private Hospital, Australia
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46
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Lam M, Li L, Anderson KK, Shariff SZ, Forchuk C. Evaluation of the transitional discharge model on use of psychiatric health services: An interrupted time series analysis. J Psychiatr Ment Health Nurs 2020; 27:172-184. [PMID: 31529589 DOI: 10.1111/jpm.12562] [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: 02/14/2019] [Revised: 07/06/2019] [Accepted: 09/12/2019] [Indexed: 10/26/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital. Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts. The transitional discharge model (TDM) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous TDM studies in Canada only examined tertiary care units, but many patients also receive care in acute care units. Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after TDM and then decreased over time for acute care units, whereas no change was observed for tertiary care units. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model. The effectiveness of TDM may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units. ABSTRACT: Introduction The transitional discharge model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support. Aim To compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada. Method Using health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates and mental health-related emergency department visit rates were compared using segmented regression analyses. Results Among acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units. Discussion Studies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices. Implications for Practice Needs of people from different unit types should be considered when implementing TDM. Nurses should recognize the development of therapeutic relationships and availability of peer support resources.
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Affiliation(s)
| | - Lihua Li
- ICES Western, London, ON, Canada
| | - Kelly K Anderson
- ICES Western, London, ON, Canada.,Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada
| | | | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
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47
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Tseng MCM, Chang CH, Liao SC, Yeh YC. Length of stay in relation to the risk of inpatient and post-discharge suicides: A national health insurance claim data study. J Affect Disord 2020; 266:528-533. [PMID: 32056922 DOI: 10.1016/j.jad.2020.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to compare the predictors of suicides among psychiatric inpatients and recently discharged patients and to examine the association between the length of stay and suicides. METHODS Data from psychiatric inpatients were extracted from the National Health Insurance databank and merged with information from the Cause of Death data using unique identification numbers. Poisson regression analyses were used to estimate the incidence rate ratio for inpatient and post-discharge suicides, which included the variables of sex, age, psychiatric diagnosis, and number of admissions in the preceding year. The associations between length of stay and inpatient and post-discharge suicide were examined using multivariate Poisson regression analyses that were adjusted for these variables. RESULTS A diagnosis of affective disorders and a higher number of previous admissions increased both inpatient and post-discharge suicides. Patients older than 15-24 years had a significantly lower inpatient suicide risk but were more likely to die by suicide post-discharge. The risk of suicide both during the inpatient stay and post-discharge statistically significantly decreased when the length of stay was longer. LIMITATIONS As there were variations in societal, environmental, and facility-level factors that might have influenced the association between length of stay and suicide, the generalization of our findings to different settings may be impeded. CONCLUSIONS This study provides additional evidence that hospitalization helps to reduce the suicide risk. It suggests that medical professionals should be alert to inpatient suicide and that they should determine the optimal length of stay considering post-discharge suicide.
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Affiliation(s)
- Mei-Chih Meg Tseng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City 22061, Taiwan.
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei 10055, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei 10055, Taiwan
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48
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Han X, Jiang F, Tang Y, Needleman J, Guo M, Chen Y, Zhou H, Liu Y. Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis. BMC Psychiatry 2020; 20:113. [PMID: 32160906 PMCID: PMC7065326 DOI: 10.1186/s12888-020-02515-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China. METHODS Data on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics. RESULTS The 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04-1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56-0.91) and frequent readmissions (OR 0.60, 95%CI 0.40-0.91). CONCLUSION More than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.
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Affiliation(s)
- Xueyan Han
- grid.413106.10000 0000 9889 6335School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China
| | - Feng Jiang
- grid.413106.10000 0000 9889 6335School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China
| | - Yilang Tang
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite, Atlanta, GA 300 USA ,grid.414026.50000 0004 0419 4084Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA USA
| | - Jack Needleman
- grid.19006.3e0000 0000 9632 6718Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS Box, Los Angeles, CA 951772 USA
| | - Moning Guo
- Beijing Municipal Health Commission Information Centre, No. 277 Zhao Deng Yu Lu, Xicheng District, Beijing, China
| | - Yin Chen
- grid.449412.ePeking University International Hospital, No. 29 Sheng Ming Yuan Lu, Haidian District, Beijing, China
| | - Huixuan Zhou
- grid.413106.10000 0000 9889 6335School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China ,grid.411614.70000 0001 2223 5394School of Sport Science, Beijing Sport University, No. 48 Xin Xi Lu, Haidian District, Beijing, China
| | - Yuanli Liu
- School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China.
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49
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Sveticic J, Turner K, Bethi S, Krishnaiah R, Williams L, Almeida-Crasto A, Stapelberg NJC, Roy S. Short stay unit for patients in acute mental health crisis: A case-control study of readmission rates. Asia Pac Psychiatry 2020; 12:e12376. [PMID: 31883230 DOI: 10.1111/appy.12376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Past evaluations of psychiatric short stay units have shown positive outcomes for patients, yet very little is known about the factors related to readmissions. METHODS A Short Stay Pathway (SSP) has been introduced on the Gold Coast, Australia, for patients in acute mental health crisis with admissions of up to 3 days. Rates of readmissions within 28 days were compared for SSP patients (N = 678), and a diagnosis-matched control group of patients from acute mental health beds (N = 1356). Demographic and clinical factors were considered as predictors of subsequent readmissions. RESULTS Average length of stay for SSP patients was 3.4 days, compared to 7.6 days in the control group. 10.6% of SSP patients and 18.4% of the control group were readmitted within 28 days (P < .001). For both groups, a 7-day follow up significantly reduced readmissions (P < .05). Indigenous patients on SSP had higher odds of readmissions than non-Indigenous patients (P < .05), and a diagnosis of a personality disorder increased readmission in the control group but not the SSP group (P < .001). DISCUSSION SSP reduced repeated hospitalizations for patients in acute crisis by 42%. An identification of factors related to future admissions can inform future tailoring of this model of care to subgroups of patients.
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Affiliation(s)
- Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Shailendhra Bethi
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Ravikumar Krishnaiah
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Lee Williams
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Alice Almeida-Crasto
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Nicolas J C Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Samit Roy
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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50
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Schmidt M, Garmy P, Stjernswärd S, Janlöv AC. Professionals' Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services. Issues Ment Health Nurs 2020; 41:182-193. [PMID: 31930924 DOI: 10.1080/01612840.2019.1663565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study explores how professionals experience persons who frequently use psychiatric emergency services (PES) in terms of their needs in Sweden. The data comprise 19 semi-structured individual interviews and one focus group interview with healthcare professionals (i.e., assistant nurses, psychiatric nurses, intern physicians, and resident physicians), which are analyzed using qualitative content analysis. The overall findings suggest that persons who frequently use PES suffer from illness, unfavorable life circumstances, and inadequate care, which together emphasize the need for more sustainable support. The findings indicate that the professionals saw beyond illness-related needs and could also acknowledge patients' needs originating from social, existential, and care- and support-related aspects of life.
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Affiliation(s)
- Manuela Schmidt
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Pernilla Garmy
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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