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PubMed1994

[Inpatient psychotherapy of anxiety disorders--a comparison of therapeutic effectiveness in patients with generalized anxiety disorder, agoraphobia and panic disorder].

We investigated the effect of psychoanalytically oriented inpatient psychotherapy on three essential forms of anxiety disorders (classified according ICD-10): 1. generalized anxiety disorder (n = 23), agoraphobia (n = 38) and panic disorder (n = 24). Examinations with psychometric test instruments were performed at beginning of inpatient psychotherapy, at dismissal and 6 weeks after dismissal. At the end of inpatient psychotherapy we judged four clinically relevant criteria of therapy success: at the one side the therapist's judgement of symptomatic and structural improvement of the patients, at the other side the patients' judgement of anxiety and depression diminuation. The results demonstrate that summing up these four success criteria 1.) 40.0% of the patients with anxiety disorders improved, 21.2% failed; 2.) 61.4% of the patients with agoraphobia improved, 6.3% failed and 3.) 52.5% of the patients with panic disorder improved, 6.5% failed. An additional analysis of these results showed that the patients with generalized anxiety disorder were significantly (p < 0.01) more disturbed (according clinical assessment) compared to the other two diagnostic groups. About 60% of these patients exhibited increased anxiety symptoms during the course of inpatients psychotherapy, nevertheless relative to the other success criteria these patients achieved satisfactory outcome results. In the paper the consequences of these findings are discussed especially for inpatient psychotherapy of severely disturbed patients with anxiety disorders.

Adult↗
PubMed1993

Physician inpatient order writing on microcomputer workstations. Effects on resource utilization.

OBJECTIVE: To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. DESIGN: Randomized controlled clinical trial. SETTING: Inpatient internal medicine service of an urban public hospital. SUBJECTS: A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. INTERVENTION: Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. MAIN OUTCOME MEASURES: Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. RESULTS: Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P = .02). Significant reductions (P < .05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P = .11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P < .0001). CONCLUSIONS: A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

Computer Communication Networks↗
PubMed1996

Inpatient stays for patients diagnosed with severe psychiatric disorders and substance abuse.

OBJECTIVE: To empirically determine if a substance abuse comorbidity is related to longer inpatient stays for patients diagnosed with schizophrenia and affective psychoses. STUDY DESIGN: A cross-sectional analysis of patients in three states: Maryland, California, and Arizona. Using multivariate techniques, we control for the effects of patient severity, insurance, and hospital characteristics on length of stay. DATA COLLECTION: We used a patient-level and state-specific hospital discharge database merged with hospital characteristics from the American Hospital Association. PRINCIPAL FINDINGS: The conventional wisdom is that patients with a substance abuse comorbidity have longer inpatient stays than similar patients without a substance abuse comorbidity. We did not observe this trend. We found wide variation in length of stay by state and patients' health insurance. In some cases, length of stay was statistically shorter for patients with a substance abuse comorbidity. CONCLUSIONS: Our research demonstrates that a substance abuse comorbidity does not necessarily equate to longer inpatient stays and that previous studies may overstate the impact of substance abuse on inpatient care utilization. In addition, we find that a relationship between substance abuse and length of stay may not be generalizable across states, diagnoses, hospitals, and/or insurance types. Future studies of the impact of substance abuse on inpatient stays need to control for these important covariates.

Acute Disease↗
PubMed1997

Ambulatory and inpatient procedures in the United States, 1994.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1994. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). The NHDS provides data on hospital inpatient care, and the NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For the NHDS, data were collected for approximately 277,000 discharges from 478 non-Federal short-stay hospitals (93 percent response rate). For the NSAS, data were collected for about 118,000 ambulatory surgery discharges from 494 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 68.4 million procedures were performed on 38.0 million discharges from hospitals and freestanding ambulatory surgery centers during 1994: 40.7 million procedures were for inpatients, and 27.7 million were for ambulatory patients. Females had more procedures than males did and the rate of procedures increased with age in both ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of large intestine, arteriography and angiocardiography, endoscopy of small intestine, and extraction of lens.

Adolescent↗
PubMed1998

Ambulatory and inpatient procedures in the United States, 1995.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1995. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 263,000 discharges from 466 non-Federal short-stay hospitals (92 percent response rate). For NSAS, data were collected for approximately 122,000 ambulatory surgery discharges from 489 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 69.2 million procedures were performed on 38.7 million discharges from hospitals and freestanding ambulatory surgery centers during 1995: 39.8 million procedures were for inpatients, and 29.4 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of small intestine, arteriography and angiocardiography, extraction of lens, and endoscopy of large intestine.

Adolescent↗
PubMed1998

Ambulatory and inpatient procedures in the United States, 1996.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1996. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery-(NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 282,000 discharges from 480 non-Federal short-stay hospitals (95 percent response rate). For NSAS, data were collected for approximately 125,000 ambulatory surgery discharges from 488 hospitals and freestanding ambulatory surgery centers (81 percent response rate). RESULTS: An estimated 71.9 million procedures were performed on 39.9 million discharges from hospitals and freestanding ambulatory surgery centers during 1996: 40.4 million procedures were for inpatients, and 31.5 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were arteriography and angiocardiography, endoscopy of small intestine, endoscopy of large intestine, and extraction of lens.

Adolescent↗
PubMed2005

Validity and reliability of an inpatient severity of psychiatric illness measure.

Inpatient psychiatric severity measures are often used but few psychometric data are available. This study evaluated the psychometric properties (reliability and validity) of a measure used to assess severity of psychiatric illness among inpatients. Using the severity measure, minimally trained raters conducted retrospective patient record reviews to assess medical necessity for psychiatric hospitalization. The data analysis compared 135 civilly committed psychiatric inpatients with a heterogeneous group of 248 psychiatric inpatients at a general hospital. The severity measure showed acceptable inter-rater reliability in both populations. Two-way analysis of variance showed that the intra-class correlation coefficient for the total score was 0.65 for general hospital subjects and 0.63 for civilly committed subjects. Differences in mean scores were substantial (15 out of a possible 75 points for general hospital subjects versus 42 for civilly committed subjects, Mann-Whitney U = 562, p < 0.001). As expected, all civilly committed subjects were well above admission cut-off score of 12, versus only 64% of the general hospital patients. The measure is appropriate for retrospective severity assessment and may also be useful for pre-admission screening.

Adult↗
PubMed2005

Utilization of fluoroquinolones and Escherichia coli resistance in urinary tract infection: inpatients and outpatients.

OBJECTIVES: The aim of this study was to evaluate the dependence of Escherichia coli resistance to fluoroquinolones on their use in the outpatients and inpatients in the Olomouc region of the Czech Republic. METHODS: Data on inpatient antibiotic use were obtained from the database of the Department of Pharmacology and expressed as defined daily dose per 100 bed-days (DBD). Data on outpatient prescriptions were obtained from the database of General Health Insurance Company and expressed in defined daily doses per 1000 clients per day (DID). Escherichia coli strains were isolated from samples of urine of both community and hospitalized patients suffering from acute bacterial urinary tract infection, examined using aerobic cultivation, and determined by standard biochemical procedures. RESULTS: The utilization of fluoroquinolones in inpatients has significantly (p < 0.01) increased from 2.52 DBD in 1997 to 4.29 DBD in 2002. In outpatients, fluoroquinolone utilization has also increased significantly from 0.14 to 0.95 DID (p < 0.01). In the same period, 9192 E. coli strains were isolated from inpatients and outpatients suffering by urinary tract infections and tested for the susceptibility to fluoroquinolones. Resistance increased significantly (p < 0.01) both in the hospital (from 2 to 9%) and in the community (from 1 to 10%). The development of E. coli resistance to fluoroquinolones correlates significantly with their utilization both in the hospital (r = 0.944, p = 0.005) and in the community (r = 0.859, p = 0.029). CONCLUSIONS: Results of this study shows the impact of fluoroquinolone utilization on E. coli resistance and support the need of controlled use of these effective antibiotics.

Anti-Infective Agents, Urinary↗
PubMed1996

A prospective, randomized controlled trial of inpatient versus outpatient continence programs in the treatment of urinary incontinence in the female.

Seventy-four patients presenting with a mixed pattern of urinary symptoms were randomly allocated to undergo either inpatient or outpatient continence programs as initial treatment, without prior urodynamic investigation. Both programs consisted of physiotherapy, bladder retraining, fluid normalization, dietary advice and general support and advice. Nine out of 39 in the outpatient group and 8 out of the 35 of the inpatient group failed to complete the study. There was a significant decrease in frequency, nocturia, number of incontinent episodes and visual analog scores for both groups. In addition the outpatients had a significant reduction in loss on pad testing, and a significantly greater improvement in their visual analog score. In each group 63% were cured or improved to the extent that they did not require further treatment. Staff costs per outpatient were half those for an inpatient. We conclude that outpatient conservative treatment as detailed above is a successful first-line treatment of urinary incontinence in women. It is as successful and possibly better than inpatient treatment, and is significantly cheaper.

Adult↗
PubMedDate not supplied

The effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service.

OBJECTIVES: 1) to determine the rate of alcoholism among general internal medicine inpatients, 2) to assess the recognition and referral rates of these patients by their physicians, 3) to determine the effect of patient gender on physician recognition of alcoholism, and 4) to compare the observed alcoholism rates with rates reported in frequently cited studies, controlling for gender distribution. DESIGN: Cross-sectional study, face-to-face interviews. SETTING: A large, county-owned metropolitan teaching hospital. PATIENTS/PARTICIPANTS: Adult patients admitted to an inpatient general medical firm. From among 95 consecutive admissions, 78 patients (81%) entered the study. INTERVENTION: The Michigan Alcoholism Screening Test (MAST) was administered to all study subjects. Chart reviews provided evidence of physician recognition and referral of patients with alcoholism. The observed rate of alcoholism was compared with rates reported in frequently cited studies after stratifying by type of service sampled and alcoholism assessment method used. Rates were then standardized for gender using the direct method. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients (28%) were found to be alcoholic by MAST criteria (scores of 5 or higher). Scores in the range indicative of alcoholism were observed more frequently among the 36 men than among the 42 women (p = 0.002) and varied by age group. Only the interaction between gender and age group was significant (p = 0.023). Sixteen of the 22 patients (73%) with alcoholism by MAST criteria were identified as alcoholic by physician evaluation. Physicians were significantly more likely to identify as alcoholic those patients with MAST scores higher than 29 and tended to more readily identify men who had alcoholism than women. Among physician-identified patients, only about one in five was referred for rehabilitation. The standardized alcoholism rate found (291/1,000) ranked about halfway between the highest and the lowest standardized rates from nine other studies of medicine inpatient services (465/1,000 and 112/1,000). CONCLUSIONS: Patient gender affected the prevalence of alcoholism and influenced its recognition by physicians. Alcoholism by MAST criteria was found in one in eight female and nearly one in two male inpatients. Physician recognition was higher for men and for more severely affected patients. An understanding of gender effects is essential to the appropriate interpretation of the results of screening tests for alcoholism and to understanding differences in reported crude rates of alcoholism among studies. Supplementing clinical impressions with the routine use of standardized methods for detecting alcoholism is recommended.

Adult↗
PubMed2004

[Pain treatment facilities in Germany. Ambulatory, day care and inpatient facilities for patients with chronic pain].

Specialised pain treatment is available at inpatient, daycare and outpatient units at hospitals in Germany. A total of 579 hospitals in Germany offer at least one of the three pain treatment options. The main treatment involves outpatient care, but inpatient wards and daycare institutions have become more common. The type and number of pain treatment facilities differ regionally. Five of the 16 counties do not officially offer inpatient care at all, although pain treatment sites have been opened on the initiative of the hospitals themselves. Since specialised pain treatment is insufficiently defined by diagnosis (ICD-10) or procedures (OPS) in the German DRG system, it is not possible to recognise its availability when the facilities are not officially named. Pain treatment should be differentiated dependent on whether patients are treated within a single area of expertise or by specialised multi-professional pain facilities. At hospitals, systematic multimodal pain treatment is possible. Inpatient and daycare pain treatment programs are suitable when outpatient treatment has failed. An overview of the pain therapies offered is a prerequisite for their optimal use, the demonstration of their necessity and for their continued development throughout Germany. This study was planned and supervised by the commission for quality assurance of the German IASP chapter and was sponsored by the German IASP chapter.

Chronic Disease↗
PubMed2004

DRD4 receptor gene exon III polymorphism in inpatient suicidal adolescents.

Some studies have suggested possible association of the dopamine receptor subtype 4 (DRD4) gene exon III 48 bp repeat polymorphism with novelty seeking behavior. As suicidal behavior in adolescents is linked to risk taking behavior, we evaluated the association of suicidality with DRD4 polymorphism in Israeli inpatient suicidal adolescents. Sixty-nine inpatient adolescents who recently attempted suicide were assessed by structured interview and rating scales for detailed clinical history, diagnoses, suicide intent and risk, impulsivity, violence, and depression. The frequency of DRD4 alleles was compared between the suicidal inpatients and 167 healthy control subjects. No significant association between the DRD4 polymorphism and suicidal behavior was found. Analysis of the suicide-related measures demonstrated a significant difference in depression severity between suicidal inpatients homozygote and heterozygote for the DRD4 alleles (p=0.003). The relevance of this finding to increased depression severity in suicidal adolescents, if replicated, is as yet unclear.

Adolescent↗
PubMed2006

Pathological gamblers: inpatients' versus outpatients' characteristics.

Several researchers and clinicians have questioned the advantages and disadvantages of inpatient and outpatient treatment for people suffering from pathological gambling. This study compares the characteristics of pathological gamblers seeking inpatient and outpatient treatment. A total of 233 pathological gamblers (inpatients = 134, outpatients = 99) participated in the study. Results show that inpatients have more severe gambling problems than those receiving outpatient services. Similar results were obtained on most other related variables such as anxiety, depression, alcohol consumption, and comorbidity. These results are discussed in terms of the costs and benefits of these two treatment modalities.

Adult↗
PubMedDate not supplied

Cognitive function in elderly non-insulin-dependent diabetic patients before and after inpatient treatment for metabolic control.

Cognitive function was measured before and after inpatient treatment for metabolic control in 20 elderly patients with non-insulin-dependent diabetes mellitus (NIDDM). Another 20 patients still on the waiting list for this treatment, served as a control group. Glycosylated hemoglobin decreased in both groups. Psychomotor speed and concentration improved only after inpatient treatment (p < 0.01; p < 0.05, respectively). Improved performance was maintained and even enhanced 6 weeks after discharge from inpatient treatment. Performance in concentration tasks correlated with glycosylated hemoglobin (p < 0.05). It is concluded that cognitive deficits in elderly NIDDM patients can be reduced by inpatient treatment, although the benefit of glycemic control was not clearly demonstrated in this study.

Aged↗
PubMed2004

State of the science: outcomes of acute inpatient psychiatric care.

Identifying client outcomes related to nursing care is critical to establish empirical evidence that supports the effectiveness of psychiatric nursing. The purpose of this article is to conduct a methodological review of the literature that examines client outcomes after treatment in acute care inpatient psychiatric hospitals and psychiatric units of general hospitals. The databases Medline, CINAHL, HealthSTAR/Ovid HealthSTAR and psycINFO were searched for articles published between 1991and 2004. A review of literature was conducted of studies related to client outcomes after inpatient psychiatric treatment. Forty-seven studies were reviewed. There is a dearth of literature related to client outcomes after inpatient psychiatric treatment. The existing literature has conceptual and methodological limitations. The organization of psychiatric nursing care, in relation to outcomes is nonexistent in the literature. Outcomes that are sensitive to nursing care must be conceptualized theoretically and then examined empirically. The Quality Health Outcomes model is proposed to conceptualize outcomes of acute inpatient psychiatric treatment that are sensitive to nursing interventions and the organization of nursing care.

Acute Disease↗
PubMed2006

Illness behaviour in neurological inpatients with psychiatric morbidity.

OBJECTIVE: The aim of the present study was to examine whether psychiatric morbidity can influence the type of illness behaviour of neurological inpatients. METHODS: For this purpose, we compared neurological inpatients with and without psychiatric disorders (DSM-IIIR criteria) for the seven scales of Illness Behaviour Questionnaire (IBQ) and searched for possible differences between the two patient subgroups. RESULTS: Of the 105 neurological inpatients who participated in the study, 54 (51.4%) were diagnosed as having some type of psychiatric disorder. These patients scored significantly higher than patients without psychiatric morbidity in the scale of Irritability. A suggestive trend for higher scores in the scales of Hypochondriasis, Disease Conviction, and Affective Disturbance, and significantly lower score in the scale of Denial, in patients with psychiatric morbidity, were also found. CONCLUSION: The present study has shown that neurological inpatients with psychiatric morbidity tend to develop more intense illness behaviour than those without. The effect of psychiatric morbidity on certain components of illness behaviour in neurological patients can be taken into account when therapeutic strategies are planned.

Adolescent↗
PubMed2006

The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use.

OBJECTIVE: To test whether utilization of infant preventive care services has reduced utilization of inpatient care and to determine whether implementation of Taiwan's National Health Insurance (NHI) has brought about any differences in the utilization of infant health care services. DATA SOURCES: Data were taken from the 1989 and 1996 National Maternal and Infant Health Surveys (NMIHSs). In total, 1662 and 3623 effective samples were used in the study from the 2 years. STUDY DESIGN: We constructed a simultaneous recursive model to obtain efficient estimates by treating preventive care (neonatal care and well-baby care) and inpatient care (hospitalization admissions) as dependent variables. PRINCIPAL FINDINGS: Utilization of neonatal care had strongly negative significant coefficients for the likelihood of being admitted to the hospital. The impact of the NHI was found to be significant. CONCLUSIONS: The hypothesis that the NHI interferes with the effectiveness of preventive care at reducing inpatient care use was not reinforced. Since support from the NHI depends on a balance of push and pull between access to inpatient care and the benefits of preventive care, it can further improve infant health by promoting the benefits of preventive care while making both types of care more accessible.

Child Health Services↗
PubMed2005

The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experience at Vanderbilt.

The authors describe a pragmatic approach to the introduction of clinical decision support at the point of care, based on a decade of experience in developing and evolving Vanderbilt's inpatient "WizOrder" care provider order entry (CPOE) system. The inpatient care setting provides a unique opportunity to interject CPOE-based decision support features that restructure clinical workflows, deliver focused relevant educational materials, and influence how care is delivered to patients. From their empirical observations, the authors have developed a generic model for decision support within inpatient CPOE systems. They believe that the model's utility extends beyond Vanderbilt, because it is based on characteristics of end-user workflows and on decision support considerations that are common to a variety of inpatient settings and CPOE systems. The specific approach to implementing a given clinical decision support feature within a CPOE system should involve evaluation along three axes: what type of intervention to create (for which the authors describe 4 general categories); when to introduce the intervention into the user's workflow (for which the authors present 7 categories), and how disruptive, during use of the system, the intervention might be to end-users' workflows (for which the authors describe 6 categories). Framing decision support in this manner may help both developers and clinical end-users plan future alterations to their systems when needs for new decision support features arise.

Admitting Department, Hospital↗