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PubMed2006

Evaluation of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER) as a measure of treatment effectiveness with psychiatric inpatients.

Assessment procedures to evaluate inpatient treatment effectiveness can provide information to inform clinical practice. The Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER) represents a standardized approach to assess patients' target problems that combines elements of individualized and nomothetic approaches. Although previous evaluations of CASPER with other patient populations have been encouraging, its use as a measure of change with an inpatient population has not been examined. In this study, 75 psychiatric inpatients completed CASPER and the Behavior and Symptom Identification Scale-32 (BASIS-32) at hospital admission and discharge. Results supported the concurrent validity of CASPER as a measure of pre- and posttreatment functioning and suggested that CASPER may provide a sensitive measure of change during inpatient treatment. Findings also supported the notion that patients' ratings of the extent to which their treatment focused on the problems they identified as a high priority were related to their overall treatment satisfaction.

Adult↗
PubMed1998

The MMPI-A and 13-year-old inpatients: how young is too young?

This study examined two questions in the use of the MMPI-A with 13-year-old inpatients: (a) are the profiles of 13-year-old inpatients markedly different from those produced by 14-year-old inpatients, and (b) what is the effect of scoring with standard MMPI-A norms versus Archer MMPI-A norms for 13-year-olds. Protocols from 56 13-year-old and 85 14-year-old psychiatric inpatients were analyzed. No significant differences were found for age in mean T scores, and no clear pattern of differences was found in percentage of elevations into the clinical range (T 65) for validity, clinical, content, or supplemental scales. A strong multivariate effect was found with the use of Archer MMPI-A norms resulting in lower T-score values than when standard MMPI-A norms are used. However, univariate differences based on norms were not routinely found with statistically significant differences in only 2 of the 38 scales for males and 7 of the 38 scales for females. The two major exceptions to this finding were that the use of Archer norms versus standard MMPI-A norms resulting in significantly higher mean T scores and a significantly higher percentage of cases falling within the clinical range for Scale 1 and the depression content scale.

Adolescent↗
PubMed2006

Improvement in cognitive and psychosocial functioning and self image among adolescent inpatient suicide attempters.

BACKGROUND: Psychiatric treatment of suicidal youths is often difficult and non-compliance in treatment is a significant problem. This prospective study compared characteristics and changes in cognitive functioning, self image and psychosocial functioning among 13 to 18 year-old adolescent psychiatric inpatients with suicide attempts (n = 16) and with no suicidality (n = 39) METHODS: The two-group pre-post test prospective study design included assessments by a psychiatrist, a psychologist and medical staff members as well as self-rated measures. DSM-III-R diagnoses were assigned using the SCID and thereafter transformed to DSM-IV diagnoses. Staff members assessed psychosocial functioning using the Global Assessment Scale (GAS). Cognitive performance was assessed using the Wechsler Adult Intelligence Scale, while the Offer Self-Image Questionnaire (OSIQ) was used to assess the subjects' self-image. ANCOVA with repeated measures was used to test changes from entry to discharge among the suicide attempters and non suicidal patients. Logistic regression modeling was used to assess variables associated with an improvement of 10 points or more in the GAS score. RESULTS: Among suicide attempter patients, psychosocial functioning, cognitive performance and both the psychological self and body-image improved during treatment and their treatment compliance and outcome were as good as that of the non-suicidal patients. Suicidal ideation and hopelessness declined, and psychosocial functioning improved. Changes in verbal cognitive performance were more pronounced among the suicide attempters. Having an improved body-image associated with a higher probability of improvement in psychosocial functioning while higher GAS score at entry was associated with lower probability of functional improvement in both patient groups. CONCLUSION: These findings illustrate that a multimodal treatment program seems to improve psychosocial functioning and self-image among severely disordered suicidal adolescent inpatients. There were no changes in familial relationships, possibly indicating a need for more intensive family interventions when treating suicidal youths. Multimodal inpatient treatment including an individual therapeutic relationship seems recommendable for severely impaired psychiatric inpatients tailored to the suicidal adolescent's needs.

Adolescent↗
PubMed2006

The effect of inpatient rehabilitation programmes on quality of life in patients with cystic fibrosis: a multi-center study.

BACKGROUND: Disease-specific, multimodal inpatient rehabilitation programmes are designed to improve the physical, emotional, and social functioning of patients with cystic fibrosis (CF). This study investigates the effects of a 4-week inpatient rehabilitation program on health-related quality of life (QL). METHODS: 84 German patients with CF (16-62 years of age, FEV1 mean 52.9% of the predicted), participating in an inpatient rehabilitation programme, completed the Questions on Life Satisfaction-Modules (FLZM) at the beginning and one month after the end of intervention. The FLZM allows the multi-dimensional evaluation of subjectively perceived satisfaction with general and health-specific life domains. In addition, medical parameters (FEV1, Body Mass Index) and socio-demographic data were registered. RESULTS: Compared to the baseline scores, after rehabilitation, participants were significantly more satisfied with general, health-related, and CF-related aspects of their lives. Specifically, improvement was noted in the following items: breathing difficulties/cough, sleep, integration of therapy into daily routine, leisure activities, general health perception, physical condition and being free from anxiety. CONCLUSION: Comprehensive inpatient rehabilitation programmes are a promising strategy to improve the quality of life of adolescent and adult CF-patients.

Activities of Daily Living↗
PubMed1999

Inpatient rehabilitation in multiple sclerosis: do the benefits carry over into the community?

OBJECTIVE: To determine the duration and pattern of carry-over of benefits gained after a short period of multidisciplinary inpatient rehabilitation. BACKGROUND: Few studies have evaluated the outcome of rehabilitation after discharge. Long-term follow-up is required to establish whether gains made during the inpatient stay are sustained over time and in the patient's own environment. METHODS: Prospective single-group longitudinal study. Fifty consecutive patients with progressive MS undergoing inpatient rehabilitation were followed for 12 months after discharge. Assessments were undertaken on admission (A), at discharge, and subsequently at 3-month intervals for 1 year (1Y) with a battery of measures addressing neurologic status, disability, handicap, quality of life, and emotional well-being. The time taken to return to baseline level was calculated using summary measures, and trends in performance levels were plotted. RESULTS: Twelve-month data were collected for 92% of patients. Although neurologic status declined (median Expanded Disability Status Scale scores: A = 6.8, 1Y = 8.0), improvements were maintained in disability and handicap for 6 months, emotional well-being for 7 months, and health-related quality of life (physical component) for 10 months. CONCLUSIONS: The benefits gained from rehabilitation were partly maintained after discharge despite worsening neurologic status. Carry-over of benefits, however, declined over time, reinforcing the need for continuity of care between the inpatient setting and the community.

Adult↗
PubMed1993

Inpatient and outpatient outcomes in Missouri's alcohol and drug treatment programs.

A comparison of the effectiveness of inpatient and outpatient services for alcohol and drug clients is presented. Controls for program completion and severity of substance use on entry to treatment are included. While inpatients do only as well as outpatients overall, inpatient services show significant advantage for particular classes of clients. Results, though preliminary, suggest that the recent call for a cutback in inpatient services is premature.

Alcoholism↗
PubMed2003

Cognitive predictors of satisfaction with hospital inpatient service encounters among the elderly: a matter of trust.

Given the burgeoning growth of the elderly population, ensuring the satisfaction of senior consumers of health services is worthy of heightened attention by healthcare administrators both on economic and social grounds. By examining inpatient satisfaction among the elderly, we have focused our attention on an important and understudied segment of health consumers within a dominant service delivery context. Moreover, we have supplemented traditional hospital service satisfaction indicators by including a variety of rarely used psychological variables as cognitive predictors of service assessments. This study reinforces the empirical connection between trust in one's physician and elderly inpatient satisfaction at an increased level. The results suggest that increased levels of trust is positively associated with overall satisfaction of elderly inpatients as well as their satisfaction with several subdimensions of service that represent specific attributes of the hospital inpatient encounter.

Aged↗
PubMed2003

Are hospital characteristics associated with parental views of pediatric inpatient care quality?

OBJECTIVE: Patient assessments of care are increasingly being considered an important dimension of quality of care. Few studies have examined the types and extent of problems identified by parents in the care of hospitalized children and whether hospital characteristics are associated with some of these problems. The objective of this study was to describe the quality of pediatric inpatient care as perceived by parents of hospitalized children and test whether hospital characteristics (academic status, market competition, freestanding children's hospital) are associated with variations in quality. METHODS: We performed a cross-sectional analysis of surveys from 6030 parents of children who were discharged for a medical condition from 38 hospitals that used the Picker Institute's Pediatric Inpatient Survey. The Pediatric Inpatient Survey measures 7 dimensions of inpatient care quality: partnership, coordination, information to parent, information to child, physical comfort, confidence and trust, and continuity and transition. Our main outcome measures included an overall quality of care rating (1 = poor, 5 = excellent), as well as overall and dimension-specific problem scores (0 = no problems, 100 = problems with 100% of processes asked about in the survey). We used Pearson correlation to determine the strength of association between the overall quality of care rating and dimension problem scores. We tested for associations between hospital characteristics and problem scores using linear regression models, controlling for patient health status and other socioeconomic status variables. RESULTS: Parents on average rated their child's care as very good (mean: 4.2) but reported problems with 27% of the survey's hospital process measures. Information to the child (33%) and coordination of care (30%) had the highest problem rates. Parent communication problems correlated most strongly with overall quality of care ratings (r = -0.49). Parents of children who were hospitalized at academic health centers (AHCs) reported 4% more problems overall (29.8% vs 25.5%) and almost 9% more problems with coordination of care (34.1% vs 25.6%) compared with those at non-AHCs. Parents in more competitive markets reported almost 3% more problems than those in the less competitive ones (28.9% vs 26.3%). The freestanding children's hospital classification was not associated with overall problem scores. We found wide variation in problem scores by hospital, even among AHCs. Hospital and patient characteristics explained only 6% of the variance in problem scores. CONCLUSIONS: Despite high subjective ratings of quality of care, measures of specific processes of care reveal significant variations among hospitals and identify areas with opportunities for improvement. Improving the quality of communication with the parent of a hospitalized child may have the most positive impact on a hospital's overall quality of care rating. AHCs and hospitals in more competitive markets may be more prone to problems. With wide variation in parental perceptions of hospital quality of care, a systems analysis of individual hospitals may provide strategies for hospitals to deliver higher quality care.

Academic Medical Centers↗
PubMed2004

Point prevalence of drug prescriptions for elderly and non-elderly inpatients in a teaching hospital.

CONTEXT: Age-related pharmacokinetic and pharmacodynamic changes have been extensively documented, and several concurrent diseases may underlie multiple drug therapy in the elderly. As a result, the risk of adverse drug reactions and drug interactions increases among aged patients. However, only a few studies have compared the prescribing patterns for different age groups of hospitalized patients or have evaluated the effect of age on drug prescription. OBJECTIVE: To compare the prevalence of drug prescriptions for elderly inpatients, with those for non-elderly inpatients, in order to assess age-related differences in the number of prescribed drugs, drug choices and prescribed doses, and to evaluate the prescription appropriateness for the elderly patients. TYPE OF STUDY: Cross-sectional survey. SETTING: 400-bed tertiary care general teaching hospital. PARTICIPANTS: All inpatients on one day of June 1995, except for the Intensive Care Unit and for the Departments of Psychiatry, Pediatrics and Obstetrics and Gynecology. PROCEDURES: All medicines prescribed to the eligible patients on the study day were recorded from the prescription sheets provided by the hospital pharmacy. MAIN MEASUREMENTS: Name, therapeutic class, and mean daily dose of the prescribed drugs. RESULTS: Of the 273 eligible inpatients, 46.5% were 14-44 years old, 33% were 45-64 years old and 20.5% were > 64 years old. Cancer was significantly more frequent among the elderly. The mean number of prescribed drugs was five for all age groups. The five most prescribed drugs for all patients were dipyrone, ranitidine, dipyrone in a fixed-dose combination, metoclopramide and cefazolin. The elderly had significantly more prescriptions for insulin, furosemide and enoxaparin. For most drugs, the mean prescribed dose showed that there was no dose adjustment for elderly patients, and drug choices for this age group were sometimes questionable. CONCLUSIONS: There was little variation in the prescribing patterns for the elderly when compared with the other age strata.

Adolescent↗
PubMed2004

Diabetes-related utilization and costs for inpatient and outpatient services in the Veterans Administration.

OBJECTIVE: -The purpose of this study was to calculate the total number of inpatient hospitalizations, outpatient clinic visits, and total direct health care costs associated with veterans with diabetes receiving care in Veterans Administration (VA) facilities. RESEARCH DESIGN AND METHODS-The number of inpatient hospitalizations is tracked for years 1994-1998, and outpatient clinic visits are tracked for years 1997 and 1998. Trends in utilization across different age and racial groups, as well as total direct inpatient and outpatient costs for 1998, are presented. RESULTS: -Between 1994 and 1998, hospitalization rates decreased from 1.68 to 1.61. The average number of outpatient visits was 4.5 in 1997 and 4.6 in 1998. VA incurred $214.8 million in outpatient expenditures and $1.45 billion in inpatient expenditures for veterans with diabetes receiving VA care. CONCLUSIONS: -Health care delivery systems and payors track the cost and utilization of services by specific patient groups to support disease management, quality improvement, external reporting, and cost containment. Tracking the utilization and cost of diabetes care is necessary to understand the financial impact of diabetes on health care systems and the overall burden of diabetes on individuals.

Aged↗
PubMed1981

Inpatient vs outpatient treatment of alcohol and drug abusers.

The literature on inpatient and outpatient treatment of alcohol and drug abusers is reviewed. In addition, attrition as a major factor in treatment is examined. While several hypothesized advantages for both inpatient and outpatient treatment are advanced, it is pointed out that, because of methodological and situational differences among the studies, comparisons are difficult and risky to make. After suggesting that there is little evidence to cause one to tout either inpatient or outpatient treatment based on relative effectiveness, it is proposed that a flexible treatment program utilizing both inpatient and outpatient treatment with a focus on reducing attrition is most likely to maximize effectiveness.

Alcoholism↗
PubMedDate not supplied

Current standards of care for inpatient glycemic management and metabolic control: is it time for definite standards and targets?

OBJECTIVE: To review the available literature on the presence of diabetes in the inpatient population and its effect on outcomes. RESULTS: Diabetes is a progressively worsening epidemic in the United States. Patients with diabetes have a disproportionate representation among the inpatient population in this country, and their share of total health-care costs is both disproportionate and growing rapidly. Patients with diabetes are often admitted to the hospital not primarily because of their diabetes but rather because of the need for treatment of the end-stage complications of diabetes, such as cardiovascular, cerebrovascular, and peripheral vascular disease as well as diabetic nephropathy and retinopathy, or because of unrelated illnesses for which diabetes is a complication. Diabetes is a frequent comorbid condition and increases the duration of hospitalization by 1 to 2 days. Numerous organizations have issued guidelines for outpatient diabetes management and metabolic control and have updated them periodically; however, no such guidelines or standards have been formulated for inpatient diabetes management. CONCLUSION: In view of a rapidly growing body of evidence suggesting that enhanced glycemic control decreases morbidity and mortality in patients with hyperglycemia, such as those with new-onset diabetes, as well as in patients with previously established diabetes, the creation of clearly defined standards and targets for inpatient management of hyperglycemia and metabolic control seems important for improvement of outcomes in hospitalized patients with diabetes.

Blood Glucose↗
PubMedDate not supplied

Inpatient management of hyperglycemia: the Northwestern experience.

OBJECTIVE: To describe a novel method of safe and effective intensive management of inpatient hyperglycemia with use of cost-effective protocols directed by a glucose management service (GMS). METHODS: An intravenous insulin protocol was designed to achieve a glycemic target of 80 to 110 mg/dL. When stable inpatients were transferred from the intravenous protocol to a subcutaneous insulin protocol, which consisted of basal long-acting and prandial and supplemental rapid-acting insulins, the blood glucose target was 80 to 150 mg/dL. Glucose levels were reviewed by the GMS at least daily for protocol adjustments, when necessary. RESULTS: The intravenous insulin protocol was used in 276 patients, and 4,058 capillary blood glucose levels were recorded. Glycemic target levels (80 to 110 mg/dL) were achieved, on average, 10.6 +/- 5.2 hours after initiation of insulin drip therapy. The mean capillary blood glucose level during the study interval was 135.3 +/- 49.9 mg/dL. Hypoglycemia (< or = 60 mg/dL) was recorded in 1.5% of glucose values, and hyperglycemia (> or = 400 mg/dL) was recorded in only 0.06%. The subcutaneous insulin protocol was used in 922 patients, and 18,067 capillary glucose levels were documented. The mean blood glucose level was 145.6 +/- 55.8 mg/dL during the study period. The blood glucose target of 80 to 150 mg/dL was achieved in 58.6%, whereas 74.3% of glycemic values were in the clinically acceptable range (80 to 180 mg/dL). Hypoglycemia (< or = 60 mg/dL) occurred in 1.3% of capillary blood glucose values, and hyperglycemia (> or = 400 mg/dL) occurred in 0.4% of values. CONCLUSION: Validated protocols dedicated to the achievement of strict glycemic goals were implemented by a GMS and resulted in substantial improvements in glycemic control on the surgical inpatient services, with a reduced frequency of hypoglycemia. The protocols and the GMS have been well received by the inpatient nursing and surgical staff members, and all of this has been done in a cost-effective manner.

Aged↗
PubMedDate not supplied

Evolution of a diabetes inpatient safety committee.

OBJECTIVE: To develop a multidisciplinary team, the Diabetes Inpatient Safety Committee (DPSC), to effectively address the many barriers to achieving glycemic control in the inpatient setting. METHODS: The development, implementation, and successes of the DPSC are described. RESULTS: By focusing on prevention of severe hypoglycemia, the DPSC identified and addressed areas related to inpatient management that contributed to uncontrolled glucose levels. The introduction of a hypoglycemia treatment protocol was followed by the development of a standardized order set for use of sliding scale insulin, with the eventual introduction of an Insulin Order Set guiding the use of scheduled and correctional insulin. Protocols and guidelines addressing more specific areas of inpatient glycemic management (insulin pump therapy, perioperative management, diabetic ketoacidosis, intravenous insulin) also have been developed. CONCLUSION: The successes of the DPSC to date have been directly related to strong institutional support, the dedication of a multidisciplinary team to address specific areas of glycemic management, the programmed introduction of order sets in conjunction with structured educational programs that accompany each protocol, and the use of quality improvement measures to evaluate the safety and efficacy of these protocols. Effective committees such as this will be instrumental in preventing errors and maximizing euglycemia.

Diabetes Mellitus↗
PubMed1990

Inpatient treatment of alcoholism: a necessary part of the therapeutic armamentarium.

Recent reviews of alcoholism treatment have argued strongly against the efficacy of inpatient treatment for alcoholic patients. This paper briefly considers the findings those reviews were based on and highlights some of the flaws that have led to the conclusion that inpatient treatment for alcoholism is unsuccessful and unnecessary. This paper suggests that the negative reports about inpatient treatment are biased and argues for the effectiveness of inpatient treatment, especially for patients with severe alcohol dependence or extensive social, psychiatric, or medical comorbidity.

Alcoholism↗
PubMed1998

[Epidemiological analysis on inpatients with epidemic encephalitis B at No. 1 Hospital of Lian Yungang from 1988-1996].

To study the morbidity and mortality of inpatients with epidemic encephalitis B (EEB) admitted to No. 1 hospital of Lian Yungang city from 1988-1996, 107 inpatients with EEB in the pediatrics department the hospital were analyzed epidemiologically. Results showed that 107 children with EEB had a proportion of 0.65% to all children admitted in the pediatrics department during that 9 years including 98 cases from the countryside and 9 cases from cities. The ratio was 10.8/1.0 when comparing countryside to city. 87 inpatients (81.3%) of EEB children were below 4 year of age consisting. Most patients were infected in late July or early August in 1990 and 1992 with number of 55 out of 107 (51.4%) that consisted 1.56% and 1.53% of the inpatients in pediatrics those years. It was concluded that EEB had a strict seasonal feature. By comparing data from the first 4 years with the latter 5 years, we noticed that the incidence of the latter had a considerable decrease with more milder cases. The morbidity and mortality of the whole city also appeared a decreasing tendency.

Child↗
PubMedDate not supplied

Adult inpatient training for a family practice residency: a university-versus community-based setting.

BACKGROUND AND OBJECTIVES: Some educators have expressed concern about the quality of inpatient training received by family practice residents in community-based residency programs because of insufficient patient numbers and resources in those programs. This study compared the number, diagnoses, and lengths of stay of patients seen by first-year family practice residents in a large inner-city, university-based medical center's internal medicine service versus those in a family practice teaching service in a smaller, community-based suburban regional hospital. METHODS: The adult inpatient training services of the two training sites were compared for 6 months to determine if any differences existed between the sites in patients'age, gender, primary and secondary diagnoses, average length of hospital stay, or in the number of monthly admissions. RESULTS: A total of 247 patients were admitted to the teaching service of the suburban community hospital, while 317 patients were admitted to the teaching service at the university hospital. The average length of stay for the suburban hospital was 6.1 days and 5.7 days at the university hospital. A total of 107 different diagnoses were made on admission at Kenner Regional Medical Center, while 90 were made at University Hospital. Chest pain/angina was the most frequent diagnosis encountered at admission at both hospitals. CONCLUSIONS: Based on the two inpatient services studied, a broad variety of diagnoses and patient demographics are encountered at community-based hospitals, with similar numbers of patients, lengths of stay, and variation in diagnoses in comparison to an urban-based university hospital. The results indicate that there can be adequate numbers of patients and diagnostic variability to permit effective inpatient teaching at community-based hospitals.

Academic Medical Centers↗
PubMed2003

[Study on the characteristics of incidence and death among inpatients with injury in Guangdong province from 1997 to 2001].

OBJECTIVE: To study the trends in the distribution and change of total injuries were explored during 1997 - 2001. To provide scientific bases in setting up priorities and improving safety standards. METHODS: To collect and analyze the data about all inpatients of injuries attending hospital and hospitalization at 322 hospitals between 1997 and 2001 in Guangdong, China. The main outcome measures included external causes, medical consequences, mortality, length of hospital stay, and costs. RESULTS: Rate of all-injury hospitalization increased yearly, from 1997 to 2001. The ratio of inpatient case-fatality declined over a 5-year period, with the total case-fatality rate of 1.64%. The inpatients were mainly caused by motor vehicle accident, unintentional falls, punctured and cut by machine, hurt by others and homicide. The constituent ratio of deaths among patients caused by motor vehicle accident was accounted for 56.13% among the total deaths, which occupied the first place. Despite the fact that the mean length of stay declined by 3.58% for the hospitalized patients over a 5 year period, and by 2.20% for the healed patients, costs increased by 3.89% for the hospitalized patients and by 4.71% for the healed patients with an average costs per patient per day increased by 7.33%. CONCLUSION: The all-injury hospitalization rate had a trend of increase from 1997 to 2001, but the ratio of inpatient case-fatality declined over the 5-year period, and the direct medical cost also had a trend of increase.

China↗