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PubMed2003

Recent trends in HIV-related inpatient admissions 1996-2000: a 7-state study.

BACKGROUND AND OBJECTIVES: HIV-related inpatient utilization declined immediately after the diffusion of highly active antiretroviral therapy (HAART), but some studies suggest that admission rates may have recently begun to increase. Using comprehensive hospital discharge data from 7 states, this study examines trends in HIV-related inpatient admissions and length of stay (LOS) from 1996 through 2000. METHODS: We identified HIV-related admissions by ICD-9-CM diagnosis codes in the range from 042 to 044. Analyses assessed differential patterns of change over time, depending on state, gender, race/ethnicity, and insurance. RESULTS: HIV-related inpatient admissions generally declined each year, but the rate of decline diminished recently. A similar pattern held for trends in inpatient LOS. Admissions for white male patients and for patients with private insurance showed the greatest decreases and the least leveling of the trend. The proportion of HIV admissions to total admissions was highest for black men and lowest for white women. In contrast to the period from 1993 through 1996, the proportion of HIV admissions covered by Medicare was greater than the rate of privately insured admissions. CONCLUSIONS: Although there is no substantial evidence for widespread increases in admissions during this period, results suggest that the trend in HIV-related hospital admissions is level in recent years. Racial/ethnic disparities in inpatient utilization persist. Further analysis of the impact of treatment failure or HAART-related complications on HIV admissions is warranted.

Female↗
PubMed2006

A paradigm for inpatient resuscitation research with an exception from informed consent.

OBJECTIVE: Resuscitation research with an exception from informed consent (EFIC) has not been reported in the inpatient or pediatric setting, and little practical information exists to guide application of EFIC regulations to inpatient or pediatric research. The objective of this study was to assess the feasibility of conducting inpatient pediatric resuscitation research with EFIC using handouts to communicate with parents of potential participants and to determine how many parents would likely allow their child to participate in such research. DESIGN: Verbal questionnaire. SETTING: Pediatric intensive care units. PARTICIPANTS: Parents of pediatric intensive care unit patients. INTERVENTIONS: Three one-page handouts described proposed studies; version 1 described a trial of a new medication given during cardiac arrest, and versions 2a and 2b described of a trial of induced hypothermia, with version 2a in paragraph format and version 2b in bullet format. We asked parents of pediatric intensive care unit patients to review the handouts, and then we administered a verbal questionnaire to assess parental reactions to the handouts and to determine how many parents would allow their child to participate. MEASUREMENTS AND MAIN RESULTS: One or both parents of 91 patients were asked to participate; 100% agreed. Sixty-three percent said they would likely allow their child to participate in resuscitation research with EFIC if they were given a prospective opportunity to opt out. Parents who reviewed version 2b (bullet format) were more likely than parents who reviewed version 2a (paragraph format) to say that they would let their child participate. Parents were more supportive of a trial of induced hypothermia than of a trial of a new medication given during cardiopulmonary resuscitation. Parents endorsed conducting the community consultation process for inpatient resuscitation research with families and healthcare providers of critically ill patients. CONCLUSIONS: Inpatient pediatric resuscitation research is feasible using handouts to inform parents of a study and provide a prospective opportunity to opt out. Succinct, bullet-format handouts will yield higher participation rates than paragraph-format handouts.

Adolescent↗
PubMed2005

Inpatient services.

PURPOSE OF REVIEW: Inpatient services constitute the most highly specialized child and adolescent mental health provision and cater for the most severe disorders in this age group. In view of a number of mapping and audit initiatives in the UK in recent years and changing influences on admission policies worldwide, it is timely to review their function and effectiveness. RECENT FINDINGS: Recent attention has focused on describing service configurations and auditing against standards. National surveys of cost, referral processes and patient satisfaction are in progress in the UK. There seems to be an international trend toward a more severe, comorbid and aggressive patient group being admitted to inpatient services. There is a shortage of quality research into clinical outcomes of inpatient treatment, but controlled trials comparing hospital treatment with intensive community management are emerging. SUMMARY: Inpatient descriptive studies and uncontrolled outcome studies predominate in the literature. Although many children and adolescents benefit from admission to mental health inpatient facilities, the specific advantages of admission over intensive community management are uncertain.

Journal Article↗
PubMed2004

Evaluating the utility of inpatient video-EEG monitoring.

PURPOSE: Inpatient video-EEG monitoring (VEM) is widely used for the diagnosis, seizure classification, and presurgical evaluation of patients with seizure disorders. It is resource intensive and relatively expensive, so its utility continues to be debated. Few studies have specifically evaluated the utility of inpatient VEM in altering diagnosis or management of patients with seizure disorders. We sought to assess the proportion of patients for whom the preadmission diagnosis and management were altered after inpatient VEM of patients admitted for diagnostic and presurgical evaluation of seizure disorders. METHODS: Data from a consecutive cohort of patients admitted over a 3-year period to an inpatient VEM unit in a tertiary referral hospital were retrospectively analyzed. The preadmission diagnosis and management by the referring neurologist was compared with the diagnosis and management after the VEM. RESULTS: Of 131 patients, 91 (70%) were admitted for diagnostic evaluation and 39 (30%) for a presurgical workup. Mean evaluative period was 5.6 days. Mean number of seizures recorded was 2.9. No seizures were recorded in 31% of patients. Interictal EEG showed epileptiform changes in 56 (43%). In 76 (58%), the diagnosis was altered as a result of the VEM, with the greatest change being an increase in the nonepileptic diagnosis group (7% to 31%) and the generalized diagnosis group (5% to 11%). Management was changed after the VEM in 95 (73%). CONCLUSIONS: The results of this study demonstrate that inpatient VEM has a high yield in changing diagnosis and management. Future long-term cost-benefit studies of the management changes resulting from VEM evaluation will aid in further reinforcing its role.

Adolescent↗
PubMed2005

Reasons for admission and their implications for the nature of acute inpatient psychiatric nursing.

The purpose of acute inpatient psychiatric care, and nurses' role within that, are in need of clarification and restatement in order to provide a framework for practice, education, research and development. Inpatient psychiatry has suffered from a paucity of research in recent years. In addition, being a complex system, involving multiple professions with differing ideologies, means that widely accepted succinct descriptions of its purpose are hard to achieve. Yet such a framework is essential to support positive attitudes to patients and for good staff-management relationships. Using an oblique strategy, this paper defines the function of acute inpatient psychiatry, and the role of psychiatric nurses, via a structured examination of the literature on reasons for admission to acute inpatient psychiatric wards. Seven such reasons were discovered and are described: dangerousness, assessment, medical treatment, severe mental disorder, self-care deficits, respite for carers, and respite for the patient. Acute inpatient psychiatric nurses are therefore: providing safety for the patient and others; collecting and communicating information about patients, giving and monitoring treatment; tolerating and managing disturbed behaviour; providing personal care; and managing an environment where patients can comfortably stay. The implications for psychiatric nursing are discussed.

Acute Disease↗
PubMed2004

The effect of HMOs on the inpatient utilization of medicare beneficiaries.

OBJECTIVE: To determine the effect of joining HMOs (health maintenance organizations) on the inpatient utilization of Medicare beneficiaries. DATA SOURCES: We linked enrollment data on Medicare beneficiaries to patient discharge data from the California Office of Statewide Health Planning and Development (OSHPD) for 1991-1995. DESIGN AND SAMPLE: A quasi-experimental design comparing inpatient utilization before and after switching from fee-for-service (FFS) to Medicare HMOs; with comparison groups of continuous FFS and HMO beneficiaries to adjust for aging and secular trends. The sample consisted of 124,111 Medicare beneficiaries who switched from FFS to HMOs in 1992 and 1993, and random samples of 108,966 continuous FFS beneficiaries and 18,276 continuous HMO enrollees yielding 1,227,105 person-year observations over five years. MAIN OUTCOMES MEASURE: Total inpatient days per thousand per year. PRINCIPAL FINDINGS: When beneficiaries joined a group/staff HMO, their total days per year were 18 percent lower (95 percent confidence interval, 15-22 percent) than if the beneficiaries had remained in FFS. Total days per year were reduced less for beneficiaries joining an IPA (independent practice association) HMO (11 percent; 95 percent confidence interval, 4-19 percent). Medicare group/staff and IPA-model HMO enrollees had roughly 60 percent of the inpatient days per thousand beneficiaries in 1995 as did FFS beneficiaries (976 and 928 versus 1,679 days per thousand, respectively). In the group/staff model HMOs, our analysis suggests that managed care practices accounted for 214 days of this difference, and the remaining 489 days (70 percent) were due to favorable selection. In IPA HMOs, managed care practices appear to account for only 115 days, with 636 days (85 percent) due to selection. CONCLUSIONS: Through the mid-nineties, Medicare HMOs in California were able to reduce inpatient utilization beyond that attributable to the high level of favorable selection, but the reduction varied by type of HMO.

Aged↗
PubMed1985

On the boundary: family therapy in a long-term inpatient setting.

The paradigm for inpatient family therapy presented here is intended both as a description of, and a means of thinking about, family therapy in a long-term inpatient setting. It is meant to contribute to a delineation of treatment goals and strategies within a conceptual framework that is rooted in and expresses the complex clinical realities of inpatient treatment, where the locus of family therapy is the family-hospital boundary. The four functions described here are hierarchical in their relationships to each other, each function emerging only in the context of the logically prior function. Although, clearly, inpatient family therapy moves through stages parallel to those of other treatment modalities (14), the purpose of this paper is to explore therapeutic functions rather than present a prescriptive, linear description of successive phases of treatment. Joining, once achieved, cannot be left behind: it needs constant attending to, though more so at some times than others. Similarly with the other functions. It is helpful when pausing to examine one's work to note those functions that, at any given time, seem to be most at issue. For instance, the family of a patient well along the road toward discharge may promote a crisis (e.g., another family member may become symptomatic, the parents' marriage might suddenly seem in danger of falling apart, or the whole thrust of the treatment may be rejected peremptorily). On such occasions the inpatient family therapist must look for precipitating factors, not just in the domain of the family and its functioning and not just in his or her relationship with the family, but also in the context of the family's relationship to the hospital. Is the hospital riding roughshod over the family's feelings? Has important information from the family been ignored? Or, has important information been neglectfully withheld from the family? Is the treatment team moving too quickly toward discharge? Are staff, then, subtly pulling back from the patient or other family members as a way of coping with their feelings of loss? Have staff somehow communicated disappointment or pessimism or despair to the family? Has the family therapist somehow inadequately represented the family's needs to the treatment team or floor staff? Do treatment decisions therefore strike the family as insensitive or thoughtless? Has the family therapist been unable to frame treatment decisions in a way the family can accept and use constructively?

Adult↗
PubMedDate not supplied

Inpatient consultation: results of a physician survey and a proposed improvement.

We undertook the current survey-based study to assess clinicians' views on the determinants of effective inpatient consultation and the existing process of inpatient consultation at the Cleveland Clinic Hospital. A 25-question survey developed for this study using Likert scale responses was completed by 181 (of 404 eligible addressees, a 45% response rate) members of the Cleveland Clinic staff in the divisions of medicine, surgery, and pediatrics. Ratings of the overall value of inpatient consultation reflected moderate satisfaction (mean 6.9 of possible 10). Types of consults that were most valued were those requesting a procedure and those seeking assistance in establishing a diagnosis and in interpreting data. Features deemed most important in making a consult excellent were legibility of the consultant's note, timeliness of the response (i.e., within 24 hours), and direct communication of the consult question. The data showed a trend indicating that physicians regarded the value of direct physician-to-physician communication more highly than they personally practiced such direct communication when requesting a consult. Study findings indicate the opportunity to improve the process of inpatient consultation by implementing measures that enhance direct physician-to-physician communication about the consult, ensure timeliness, facilitate identification of the appropriate consultants, and allow easier auditing. We propose a novel process for requesting inpatient consultations that extends currently available hospital information systems but offers a process improvement that warrants development.

Attitude of Health Personnel↗
PubMed2003

Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care.

OBJECTIVE: To assess the relative cost effectiveness of clinical nurse specialist care, inpatient team care, and day patient team care. METHODS: Incremental cost effectiveness analysis and cost utility analysis, alongside a prospective randomised controlled trial with two year follow up. Included were patients with rheumatoid arthritis (RA) with increasing difficulty in performing activities of daily living over the previous six weeks. Quality of life and utility were assessed by the Rheumatoid Arthritis Quality of Life questionnaire, the Short Form-6D, a transformed rating scale, and the time tradeoff. A cost-price analysis was conducted to estimate the costs of inpatient and day patient hospitalisations. Other healthcare and non-healthcare costs were estimated from cost questionnaires. RESULTS: 210 patients with RA (75% female, median age 59 years) were included. Aggregated over the two year follow up period, no significant differences were found on the quality of life and utility instruments. The costs of the initial treatment were estimated at euro 200 for clinical nurse specialist care, euro 5000 for inpatient team care, and euro 4100 for day patient team care. Other healthcare costs and non-healthcare costs were not significantly different. The total societal costs did not differ significantly between inpatients and day patients, but were significantly lower for the clinical nurse specialist patients by at least euro 5400. CONCLUSIONS: Compared with inpatient and day patient team care, clinical nurse specialist care was shown to provide equivalent quality of life and utility, at lower costs. Therefore, for patients with health conditions that allow for any of the three types of care, the preferred treatment from a health-economic perspective is the care provided by the clinical nurse specialist.

Activities of Daily Living↗
PubMed1986

Opiate withdrawal: inpatient versus outpatient programmes and preferred versus random assignment to treatment.

The relative effectiveness of an inpatient and an outpatient withdrawal programme for opiate addicts was studied. Forty five men and 15 women (mean age 26.13 (SD 5.12) years) took part in the study, all of whom were voluntary patients at the drug dependence clinic of the Maudsley Hospital in London between 1984 and 1985. Subjects were asked if they were prepared to accept either inpatient or outpatient withdrawal, and those who were willing to do so were assigned randomly to the randomised outpatient group or the randomised inpatient group. Those who expressed a strong preference were assigned, as appropriate, to the preferred outpatient group or the preferred inpatient group. Addicts in the inpatient group were more likely to achieve complete withdrawal (25 out of 31, 81%) than those in the outpatient group (five out of 29, 17%). This difference could not be attributed to pretreatment factors related to drugs or to social or psychological differences between the groups. These results have clinical and policy implications for the treatment of opiate addicts.

Adult↗
PubMed1998

Is day care equivalent to inpatient care for active rheumatoid arthritis? Randomised controlled clinical and economic evaluation.

OBJECTIVE: To test the clinical equivalence and resource consequences of day care with inpatient care for active rheumatoid arthritis. DESIGN: Randomised controlled clinical trial with integrated cost minimisation economic evaluation. SETTING: Rheumatic diseases unit at a teaching hospital between 1994 and 1996. SUBJECTS: 118 consecutive patients with active rheumatoid arthritis randomised to receive either day care or inpatient care. MAIN OUTCOME MEASURES: Clinical assessments recorded on admission, discharge, and follow up at 12 months comprised: the health assessment questionnaire, Ritchie articular index, erythrocyte sedimentation rate, hospital anxiety and depression scale, and Steinbrocker functional class. Resource estimates were of the direct and indirect costs relating to treatment for rheumatoid arthritis. Secondary outcome measures (health utility) were ascertained by time trade off and with the quality of well being scale. RESULTS: Both groups had improvement in scores on the health assessment questionnaire and Ritchie index and erythrocyte sedimentation rate after hospital treatment (P < 0.0001) but clinical outcome did not differ significantly between the groups either at discharge or follow up. The mean hospital cost per patient for day care, 798 Pounds (95% confidence interval 705 Pounds to 888 Pounds), was lower than for inpatient care, 1253 Pounds (1155 Pounds to 1370 Pounds), but this difference was offset by higher community, travel, and readmission costs. The difference in total cost per patient between day care and inpatient care was small (1789 Pounds (1539 Pounds to 2027 Pounds) v 2021 Pounds (1834 Pounds to 2230 Pounds)). Quantile regression analysis showed a cost difference in favour of day care up to the 50th centile (374 Pounds; 639 Pounds to 109 Pounds). CONCLUSIONS: Day care and inpatient care for patients with uncomplicated active rheumatoid arthritis have equivalent clinical outcome with a small difference in overall resource cost in favour of day care. The choice of management strategy may depend increasingly on convenience, satisfaction, or more comprehensive health measures reflecting the preferences of patients, providers, and service commissioners.

Adult↗
PubMed2000

Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections.

OBJECTIVE: To investigate the facilities for inpatient care of mentally disordered people in prison. DESIGN: Semistructured inspections conducted by doctor and nurse. Expected standards were based on healthcare quality standards published by the Prison Service or the NHS. SETTING: 13 prisons with inpatient beds in England and Wales subject to the prison inspectorate's routine inspection programme during 1997-8. MAIN OUTCOMES MEASURES: Appraisals of quality of care against published standards. RESULTS: The 13 prisons had 348 beds, 20% of all beds in prisons. Inpatient units had between 3 and 75 beds. No doctor in charge of inpatients had completed specialist psychiatric training. 24% of nursing staff had mental health training; 32% were non-nursing trained healthcare officers. Only one prison had occupational therapy input; two had input from a clinical psychologist. Most patients were unlocked for about 3.5 hours a day and none for more than nine hours a day. Four prisons provided statistics on the use of seclusion. The average length of an episode of seclusion was 50 hours. CONCLUSION: The quality of services for mentally ill prisoners fell far below the standards in the NHS. Patients' lives were unacceptably restricted and therapy limited. The present policy dividing inpatient care of mentally disordered prisoners between the prison service and the NHS needs reconsideration.

England↗
PubMed1997

Economic reforms and the acute inpatient care of patients with schizophrenia: the Chinese experience.

OBJECTIVE: This study compared insured and uninsured schizophrenic inpatients in China and examined changes in the acute inpatient care of schizophrenic patients during China's economic reform era. METHOD: Detailed chart reviews of 50 randomly selected inpatients discharged from a hospital in central China each year from 1984 through 1993 identified 321 patients with schizophrenia. Demographic, insurance, treatment, and cost data of these patients were collected from the charts. RESULTS: With logistic regression models to control for confounding variables, the analyses showed that the 129 insured patients were significantly more likely than the 192 uninsured patients to be urban residents, to be older, to have had 7 or more years of schooling, and to have had more psychiatric hospitalizations; moreover, their index admissions were longer and were more likely to include use of traditional Chinese medications. The estimated 19% of schizophrenic individuals in the community with health insurance receive inpatient treatment 2.8 times more frequently than the 81% without insurance. Compared to admissions in 1984-1988, admissions in 1989-1993 were significantly shorter and involved longer periods of polypharmacy with multiple antipsychotic medications but included lower mean chlorpromazine-equivalent doses of medication. The relative cost of inpatient care for an acute episode of schizophrenia increased 3.5-fold over the 10-year period, from 11% of mean annual household income in 1984 to 37% in 1993. CONCLUSIONS: Changes in the incentive system for care providers and rapid increases in the cost of care during the economic reform era have resulted in increasingly restricted availability of services for the many schizophrenic patients without health insurance.

Adult↗
PubMed2004

Geriatric psychiatry versus general psychiatry inpatient treatment of the elderly.

OBJECTIVE: The authors compared the clinical treatment given older psychiatric inpatients on a geriatric psychiatry unit and a general psychiatry unit. METHOD: The charts of 50 randomly selected general psychiatry inpatients over the age of 65 years and 50 inpatients from the geriatric psychiatry unit who were matched for age, gender, and primary diagnosis were reviewed. RESULTS: Significantly greater percentages of older inpatients treated on the geriatric psychiatry unit received complete organic medical workups, structured cognitive assessment, aging-sensitive aftercare referral, and monitoring of psychopharmacological side effects and blood levels than comparable patients on a general psychiatry unit. CONCLUSIONS: Geriatric psychiatry subspecialty inpatient care appears to be associated with distinct clinically relevant assessment and treatment advantages. Continuing geropsychiatric education of general psychiatrists is indicated.

Aged↗
PubMed2005

Impulse control disorders in adult psychiatric inpatients.

OBJECTIVE: The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. METHOD: They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. RESULTS: Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. CONCLUSIONS: Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.

Adolescent↗
PubMed2004

Effect of voluntariness of participation in treatment on short-term outcome of inpatients with schizophrenia.

OBJECTIVE: The purpose of this study was to examine associations between the voluntary or coercive nature of patients' participation in inpatient treatment and the short-term outcome of inpatient treatment for patients with schizophrenia. METHODS: Eighty-eight adult patients with schizophrenia and delusional disorders who were consecutively admitted to a 320-bed psychiatric hospital in southern Germany over a three-month period in 2002 were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) at admission and discharge, a mean of 36.2 days later. The patients were grouped by whether their participation was voluntary or involuntary in each of five aspects of inpatient treatment: admission, hospital stay, medication, discharge, and intention to continue treatment after discharge. Outcome was defined as the change between admission and discharge in scores on the PANSS and the GAF and change in those scores per inpatient day. RESULTS: The outcome measures were not significantly related to the voluntariness of patients' participation in any aspect of treatment. CONCLUSIONS: The short-term outcome of inpatient treatment is independent of whether treatment is voluntary.

Adolescent↗
PubMed2005

Patient characteristics and setting variables related to use of restraint on four inpatient psychiatric units for youths.

OBJECTIVES: This study examined the characteristics of children and adolescents who were restrained during brief inpatient psychiatric treatment and identified whether restraint use was related to the characteristics of the youths or to the setting-time of day, day of the week, place, or programming. Incidents related to restraint use were also examined. METHODS: Charts were reviewed for 100 youths who were admitted to four inpatient units between December 1998 and January 2000. RESULTS: Thirty-one youths were not restrained, 57 were restrained once or twice, and 12 were restrained three or more times. Youths were significantly more likely to be restrained if they were male, had multiple admissions to the facility during the study period, remained in the hospital longer, had been given a diagnosis of a psychotic disorder, or had a previous psychiatric hospitalization. Youths who were restrained were also more likely to be enrolled in special education or to be in foster care or in custody of the Department of Children and Family Services. Also, these youths were more likely to have a history of voicing suicidal ideation and attempting suicide. No single setting variable was significantly related to restraint use. Incidents that prompted restraint generally involved agitation, threats, or assaults. CONCLUSIONS: Youths who were at greatest risk of being restrained during brief inpatient treatment shared particular characteristics related to greater use of inpatient services, guardianship arrangements, special education placement, and history of suicide attempts. Inpatient staff members should remain particularly alert to the processing and regulation problems of these groups of patients.

Adolescent↗
PubMed1993

Clinical significance of inpatient family intervention: conclusions from a clinical trial.

OBJECTIVE: To test whether the statistically significant results of a randomized clinical trial of an inpatient family intervention were clinically significant for hospital practice, the authors reanalyzed outcome data using a measure of clinical significance based on the extent to which patients had recovered during the course of the intervention. METHODS: A total of 169 hospitalized subjects and their families were randomly assigned to a psychoeducational inpatient family intervention or to a comparison group. Patient and family outcome measures were assessed at admission, discharge, and six and 18 months after admission. Analyses of statistically significant differences in outcome suggested that inpatient family intervention was effective for certain patient subgroups identified by gender and diagnosis. Global Assessment Scale scores two or more standard deviations above the pretreatment (admission) mean were used as indicators for clinically significant improvement. RESULTS: The reanalysis confirmed that inpatient family intervention was associated with clinically significant improvement at discharge, especially for female patients and patients with chronic schizophrenia and bipolar disorder. These effects were maintained six months after admission before attenuating at 18 months. CONCLUSIONS: Inpatient family intervention results in clinically meaningful outcomes for certain subgroups of patients and their families.

Adult↗