Disability, outcome and case-mix in acute psychiatric in-patient units

Abstract

Routine outcome assessment using reliable and valid instruments is practical, and could lead to improvements in the quality of care for psychiatric patients.

Determinants of Geropsychiatric Inpatient Length of Stay

“…LOS was directly correlated with score on the BPRS positive symptoms subscale; very low scores (1-10) were associated with decreases in LOS while very high scores (31)(32)(33)(34)(35)(36)(37)(38)(39)(40) were associated with a greater than 82% increase. This suggests that the BPRS positive symptom subscale might be used to identify patients with potentially longer LOS.…”

“…Prior research has found increased LOS among geriatric psychiatric patients to be associated with falling while hospitalized (16)(17)(18)(19)(20)(21)40), inability to return to prior living arrangement (1,20,33), ECT (16,17), and greater severity of psychiatric illness (23,36,37,41,42). On the other hand, cognitive impairment (21,22) has not been found to influence LOS.…”

“…Inconsistent correlations with length of stay have been noted for key demographic characteristics; (1,(20)(21)(22)(23) age, gender and marital status are found to be both good (9,(24)(25)(26)(27)(28)(29)(30)(31)(32) and poor (1,14,(20)(21)(22)27,33,34) predictors of LOS. Interestingly, psychiatric diagnosis without some measure of severity and the diagnostic related groups (DRGs) used for Medicare reimbursement are also unpersuasive as predictors of LOS with as many studies finding them related to LOS (2,(5)(6)(7)17,21,22,24) as not (3,(9)(10)(11)(12)18,(35)(36)(37)(38)(39).…”

Measurement limit of quality-of-life questionnaires in psychiatric settings

“…An exception is the study that examined long-stay patients in a psychiatric hospital and showed that only 26% of the patients were able to answer the World Health Organization Quality of Life (WHOQOL), a questionnaire about QOL [13]. Another exception is the study of an acute inpatient setting in which the use of the SF-36 for outcome assessment proved not feasible [12]. Unlike the present study, these studies only address a feasibility issue surrounding the use of self-report measures of QOL.…”

“…A number of studies have begun to demonstrate that older adults with severe cognitive impairment are not capable of completing a subjective QOL assessment reliably and validly [7][8][9][10][11], but only a few studies validate QOL questionnaires in psychiatric patients with a broad spectrum of disabilities [12,13]. The aim of this study, therefore, was to clarify the measurement limit of a QOL questionnaire by examining data quality, reliability, and validity in psychiatric patients.…”