Psychiatrist Characteristics Related to Patient Outcome in Japan

Abstract

We evaluated psychiatric care in terms of the relationship between patient outcome (length of stay, Global Assessment of Functioning (GAF) at discharge, GAF difference, and GAF change per day) and psychiatrist characteristics (gender and years in psychiatric practice) in patients with schizophrenia, schizotypal, or delusional disorders (ICD-10 codes F20-F29) and in those with mood disorders (ICD-10 codes F30-F39). The sample consisted of inpatients discharged from an institute in Japan between April 2007 and March 2008. Multivariate analyses were performed to identify patient and psychiatrist characteristics related to outcome. We found that psychiatrist characteristics, such as gender and years in practice, were associated with GAF-related outcomes in patients in the F20-F29 and F30-F39 code groups (P < 0.05, P < 0.001, respectively). Patient characteristics and clinical factors such as GAF at admission, ward type, arrival by ambulance, admission type, seclusion, restraint, diagnosis, and patient age, were associated with outcome in both diagnostic groups. These findings show that gender and years in psychiatric practice had a significant effect on psychiatric patient outcome. Further studies in multiple institutes using a follow-up design are necessary to verify these findings.

Multilevel analysis of the determinants of the global assessment of functioning in an inpatient population

“…Patient-level analyses have consistently identified symptom severity as the most important determinant of GAF scores, with smaller contributions made by measures of social and occupational functioning [11-15]. There is evidence, however, that factors other than patient presentation also predict GAF scores, including psychiatrist gender and years of practice [16] and the site of treatment [17]. Although providing preliminary evidence of potential bias in GAF scores, these studies did not take into account the clustering of patients of particular types within providers and programs, or the multilevel nature of the information that is collected during routine clinical practice.…”