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PubMed1986

Referral patterns to and from inpatient psychiatric services: a social network approach.

Interorganizational linkages have assumed more import for mental health service systems during the past three decades because of increased levels of complexity in service delivery patterns. This analysis examines these linkages from a relational perspective, with network of patient referral patterns as the basic unit. Multidimensional scaling is employed to discern patterns of interorganizational linkages in national patient referral data collected by the National Institute of Mental Health in 1975 and 1980 for patient samples from inpatient psychiatric services of state and county mental hospitals, private psychiatric hospitals, and public and nonpublic general hospitals. The multidimensional scaling techniques distinguish two structural characteristics of the interorganizational linkages of psychiatric inpatient services--public vs private services, and drift over time in referral patterns. Public and private inpatient psychiatric services are differentiated principally in terms of degree of interaction with legal agencies and private practice psychiatrists. Chronological change in referral patterns is characterized principally by changes in the degree of interaction with other inpatient or outpatient psychiatric services. Methodologically and theoretically, the techniques and findings described can enhance our understanding of interorganizational linkages and dynamics.

Delivery of Health Care↗

PubMed2006

Body mass index among Japanese inpatients with schizophrenia.

BACKGROUND: Many studies have emphasized the high frequency of obesity in schizophrenic patients. However, the characteristics of the Body Mass Index (BMI) distribution in Japanese schizophrenic patients remain unknown, and the aim of this study was to clarify these characteristics in a Japanese schizophrenic inpatient population. METHODS: The subjects were 273 inpatients (males: 141, females: 132) with schizophrenia. The patient BMI distribution was compared with normal control data obtained from the 2003 Japanese National Health and Nutrition Survey. RESULTS: The mean patient BMI was 23.0 +/- 4.3, and the BMI showed a normal distribution. The proportion of patients who were obese, of normal weight and underweight was 30.8%, 53.1%, and 16.1%, respectively. No statistical evidence of a higher frequency of obesity was found in male patients, compared to normal controls, but a higher frequency of underweight patients and a lower frequency of normal-weight patients were apparent in most decades of age. In female schizophrenia patients, a higher prevalence of obesity occurred in patients aged 50-59 years old, compared to controls. A higher rate of underweight elderly patients and a lower rate of normal-weight patients aged 40 to more than 70 years old were also apparent. CONCLUSIONS: The results suggest that not only obesity but also weight problems related to an underweight condition occur more frequently in Japanese schizophrenic inpatients than in normal controls. The deviation of the BMI distribution in Japanese schizophrenic inpatients may have a relationship with higher mortality and sudden death in schizophrenia.

Body Mass Index↗

PubMed1990

Enhancing the self-esteem of inpatient alcoholics.

This study examined the effect of pairing inpatient alcoholics with nursing home residents (NHRs) on the alcoholics' self-esteem. In this PALS program, the alcoholic inpatients assumed a helping-companion relationship with the NHRs for 2 hr per day during their last 2 weeks of treatment. Fifty alcoholic inpatients were randomly assigned to the PALS program (n = 25) or to the library for free reading time (n = 25). The Tennessee Self-Concept Scale (TSCS) was administered to all subjects in both groups before and after the interventions. Of the nine TSCS scales, the improvement on the Moral-Ethical scale was significantly greater in the PALS group. Because the alcoholic inpatients in the PALS group engaged in altruistic (moral) behavior, this study provides a logical link between the intervention and the outcome, which has been a prevalent weakness in previous studies of self-esteem in alcoholics.

Alcoholism↗

PubMed1976

Hypnotic and minor tranquilizer use among inpatients and after discharge.

A major concern in prescribing hypnotics and minor tranquilizers in the hospital is that long-term habituation might develop. Former psychiatric inpatients were surveyed to assess hypnotic and minor tranquilizer use following discharge. Patients who used flurazepam and chloral hydrate as inpatients were no more likely to use these hypnotics as outpatients than patients who received no hypnotics as inpatients. There was a significant association between inpatient and outpatient use of minor tranquilizers. Outpatient use of minor tranquilizers was also significantly associated with outpatient hypnotic use.

Aftercare↗

PubMed2001

Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients.

BACKGROUND: The rate of body dysmorphic disorder (BDD) in inpatient psychiatric settings and the nature of the presenting complaints are unknown. Because of the shame and humiliation that BDD patients suffer, we hypothesized that, unless specifically screened for at the time of admission, BDD would be underdiagnosed in psychiatric inpatients. METHOD: 101 consecutive adult patients and 21 consecutive adolescent patients presenting for psychiatric inpatient admission to a university teaching hospital participated in the study. Subjects completed the Body Dysmorphic Disorder Questionnaire, a brief self-report measure that screens for BDD, and a follow-up interview was conducted using a reliable clinician-administered semistructured diagnostic instrument for DSM-IV BDD. Data concerning current diagnoses, number of hospitalizations, number of suicide attempts, and current level of functioning were also obtained. RESULTS: Sixteen (13.1%) of the 122 subjects were diagnosed with BDD. None of the subjects with BDD had been diagnosed with BDD by their treating physician during hospitalization. All 16 subjects reported that they would not raise the issue with their physician unless specifically asked due to feelings of shame. CONCLUSION: These preliminary results suggest that BDD, an underrecognized and often severe psychiatric disorder, may be relatively common in the psychiatric inpatient setting. It is important that clinicians specifically inquire about BDD because patients will not voluntarily raise these concerns. The comorbidity of this disorder with other psychiatric illnesses may have treatment implications.

Adolescent↗

PubMed2004

Characteristics of repeat users of an inpatient psychiatry service at a large military tertiary care hospital.

OBJECTIVE: The purpose of this study was to identify clinical and demographic variables that correlated with readmission to a large tertiary care military psychiatric inpatient service located in the Washington, DC area. METHODS: Data from 983 consecutive inpatient admissions (comprised of 814 individual patients) over a 13-month period (July 1999-July 2000) were abstracted from medical records for retrospective analysis. Repeat users were defined as those individuals receiving two or more inpatient admissions to Walter Reed Army Medical Center during the study period. Statistical comparisons were made between repeat and single admission groups to identify variables predictive of rehospitalization. RESULTS: Of 814 individual patients under study, 117 (14%) were identified as repeat users. A history of childhood psychiatric problems, previous psychiatric hospitalization, current or past substance abuse, legal problems, and presence of a psychotic or nonbipolar mood disorder were associated with readmission after controlling for active duty status. Current comorbid substance use or personality disorder diagnoses were not predictive. Having at least one child was protective against readmission. The 117 repeat users accounted for 3,838 (37%) of the total 10,393 hospital bed-days during the study period. Logistic regression analysis of all variables correlated with readmission demonstrated statistical significance for past psychiatric hospitalization and age of onset of psychiatric problems before age 18 when active duty status, age, and gender variables were included in the equation. CONCLUSIONS: This study is one of the largest to investigate predictors of rehospitalization in a population that enjoys universal "free" access to comprehensive mental health care services and other benefits of employment. This retrospective analysis documented three important facts: That there seem to be only minor differences between military and civilians with respect to variables associated with psychiatric rehospitalization, that a relatively small proportion of patients accounted for a disproportionately large number of inpatient bed-days, and that an unexpectedly high proportion of active duty patients admitted to this study site reported childhood psychiatric problems and psychiatric hospitalizations before their first hospitalization at Walter Reed Army Medical Center.

Adult↗

PubMed1999

["Ideal" inpatient psychiatric treatment from the viewpoint of the patients].

PURPOSE: In this study "ideal" psychiatric inpatient care from the patient's point of view was examined. METHODS: Based upon a content analysis of 38 interviews a questionnaire containing 39 items was developed to evaluate attributes of ideal psychiatric inpatient care from the patient's viewpoint. 58 of 116 patients completed the questionnaire; the analysis group was representative for acute psychiatric inpatients. RESULTS: The patients ranked highly: successful treatment, upholding of human rights, privacy, empathic doctors, competent doctors, free exit, friendly staff. Factor analysis identified four factors that may be called Psychiatric Treatment, Patient Autonomy. Staff Competence, Appointment. The ratings were not associated with sociodemographic or disease-related variables. Therapists' ratings were mostly in agreement with those of the patients', but therapists underestimated the importance of the items free exit, patients' co-influence in treatment planning, respect among the patients. The aspect of patient autonomy was also rarely found in other professionals' questionnaires. CONCLUSIONS: Findings reflecting patients' expectations regarding "ideal" psychiatric inpatient care vary. Validity of former questionnaires is reduced if important aspects of patient satisfaction are disregarded.

Germany↗

PubMed1990

Medicare program; changes to the inpatient hospital prospective payment system and fiscal year 1991 rates--HCFA. Final rule.

We are revising the Medicare inpatient hospital prospective payment system to implement necessary changes arising from legislation and our continuing experience with the system. In addition, in the Addendum to this final rule, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare inpatient hospital services. In general, these changes are applicable to discharges occurring on or after October 1, 1990. We also set forth rate-of-increase limits for hospitals and hospital units excluded from the prospective payment system. This final rule also responds to comments received concerning changes to hospital payments made in an April 20, 1990 final rule with comment. These changes include mid-year changes to the inpatient hospital prospective payment system that implemented provisions of the Omnibus Budget Reconciliation Act of 1989; and adjustments applicable to prospective payment hospitals and to the target amounts of hospitals and units excluded from the prospective payment system due to the elimination of the day limitation on covered inpatient hospital days made by the Medicare Catastrophic Coverage Act of 1988 and later repealed by provisions in the Medicare Catastrophic Repeal Act of 1989. The April 20, 1990 final rule with comment also incorporated changes to these provisions made by the Family Support Act of 1988, which clarified the criteria for adjusting the target amounts and implementation date. In addition, this final rule clarifies the documentation requirements necessary to support the cost allocation of teaching physicians and the allowability of costs for rotating residents in determining payment for the direct costs of an approved graduate medical education program. This clarification is being made as a result of a September 29, 1989 final rule that made changes in Medicare policy concerning payment for the direct graduate medical education costs of providers associated with approved residency programs in medicine, osteopathy, dentistry, and podiatry.

Centers for Medicare and Medicaid Services, U.S.↗

PubMedDate not supplied

The integration of inpatient treatment and transitional day hospital: application of a problem-solving approach.

Because of the trend in inpatient psychiatry toward a marked decrease in length of hospitalization, clinicians must reconceptualize the manner in which psychosocial treatments are organized in the inpatient milieu. Considerable data suggest that problem-solving therapies may be a productive way to integrate the groups and activities in the therapeutic milieu. This paper describes the application of a problem-solving approach to the therapeutic milieu and indicates that the therapeutic gains from this approach may be enhanced by combining inpatient treatment with a transitional day hospital program. We identify the empirical underpinnings of this model and describe how it has been used to treat a schizophrenic patient. We suggest that problem-solving therapies are effective for promoting behavioral change on the general psychiatric inpatient unit.

Adult↗

PubMed1983

Hospital and health maintenance organization financial agreements for inpatient services: a case study of the Minneapolis/St. Paul area.

With nearly a quarter of the population enrolled in Health Maintenance Organizations (HMOs) the Mineapolis/St. Paul metropolitan area provides a unique opportunity for studies dealing with the effects of prepaid health plans on the health care marketplace. This study explores one aspect of that market; discounts obtained by HMOs for hospital inpatient service. Using information gathered from structured interviews with the 7 HMOs and 30 hospitals in the Twin Cities area, the study addressed three areas of inquiry: (1) the nature of discount contracts between hospitals and HMOs, (2) the roles played by each party in initiating the contracts, and (3) factors influencing the establishment of the contracts. While each of the HMOs was found to have at least one hospital contract under which they received inpatient services for other than full-billed charges, the amount of the discount was not substantial in the majority of cases. Other factors such as hospital location and ability to provide a full range of services appear to be as important as financial discounts when HMOs select a hospital for inpatient services. It appears that hospitals played the lead role in initiating hospital/HMO contracts during the formative HMO years, but this initiative shifted to the HMOs as they gained market shares and bargaining power. Hospitals and HMOs agree that the most important factor influencing hospital willingness to consider discount contracts was and still is the surplus bed availability in the area. This surplus of beds has been exacerbated by a continued decline in hospital utilization. These conditions coupled with increased HMO market shares has recently resulted in intensified contract negotiations and further discounts for inpatient services.

Contract Services↗

PubMed1982

Medicare program; schedule of limits on hospital inpatient operating costs for cost reporting periods beginning on or after October 1, 1982--HCFA. Interim final notice with comment period.

This notice sets forth a schedule of limits on the hospital inpatient operating costs that may be reimbursed under Medicare for cost reporting periods beginning on or after October 1, 1982. These limits are needed to implement changes in the Medicare law that were made by section 101(a) of Pub. L. 97-248, the Tax Equity and Fiscal Responsibility Act of 1982. The new limits differ from the current per diem limits on inpatient general routine operating costs in several major respects. First, they are not restricted to costs of inpatient general routine care, but cover total inpatient operating costs, including the costs of general routine service, special care, and ancillary services. The new limits will be applied on a cost per discharge rather than cost per diem basis. Finally, they are adjusted to reflect differences in the mix of Medicare cases treated by each hospital. The limits are similar to the current limits in that they do not apply to outpatient service cost, capital-related costs, malpractice insurance costs, or costs a hospital allocates to the interns and residents (in approved programs) or nursing school cost centers on its Medicare cost report. They also do not apply to children's hospitals, long-term care hospitals, or rural hospitals with fewer than 50 beds. The notice explains our methodology for deriving and applying the new limits.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1988

Total charges for inpatient medical rehabilitation.

Descriptive information on inpatient charges for a sample of 151 individuals discharged from three Boston area medical rehabilitation facilities is presented in this article. The total charges for inpatient rehabilitation were nearly $3 million, and the mean charge was $19,568. Also presented are a description of how charges vary by medical, demographic, social, and external factors and an identification of predictors of total charges for inpatient medical rehabilitation. These results establish a reference point for developing prospective payment systems for inpatient medical rehabilitation.

Analysis of Variance↗

PubMedDate not supplied

[Analytical thyroid disturbances in psychiatric inpatients].

BACKGROUND: There is not an agreement about the screening for thyroid disease in psychiatric inpatients. METHODS, The thyroid status of 172 psychiatric inpatients was assessed at the beginning of their hospitalization. A logistic regression was performed lo find the factors related with abnormal levels of thyroid hormones. RESULTS: As many as 30.8% of the inpatients presented levels of thyroid hormones and 5.2% have thyroid disease. The model chi2 was excellent (chi2= 20.89; gl= 4; p< 0.0001), the sensitivity was de 0.38 and the specificity was 0.83. Five variables fulfilled the criteria to be entered and not removed from the model: sex, schizophrenia, previous mental disorder, treatment with lithium, current infectious illness. CONCLUSIONS: A screening for thyroid disorder in psychiatric inpatients, at the beginning of their hospitalization, is recommended in female patients, schizophrenics and patients in treatment with lithium.

Adult↗

PubMed1999

Can an informant questionnaire be used to predict the development of dementia in medical inpatients?

OBJECTIVE: To determine whether elderly medical inpatients without dementia who score >3.31 on the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are at an increased risk of developing dementia. DESIGN/PARTICIPANTS: Twenty-nine patients with an IQCODE score of >3.31 without dementia and 29 age- and sex-matched controls, from an original sample of 201 medical inpatients over 65, were examined 17-24 months after initial assessment. SETTING: Interviews took place in patients' homes, but all subjects had been recruited while medical inpatients in a general hospital 17-24 months previously. MEASURES: The IQCODE and clinical interview to make DSM-III-R diagnosis of dementia. RESULTS: Ten of the study group and one control had developed dementia since the original assessment. CONCLUSIONS: Non-demented elderly medical inpatients with an admission IQCODE score of >3.31 are more likely to develop dementia than those with an IQCODE score of <3.31. The IQCODE is a sensitive tool for detecting early dementia.

Aged↗

PubMedDate not supplied

[Analysis of premature termination in inpatient psychosomatic rehabilitation based on epidemiologic data from two hospital companies].

Premature termination of inpatient psychotherapy can have multiple, mostly negative, effects for patients, therapists, clinics, insurance companies, and employers, but research regarding inpatient settings is still deficient. The analysis of two sets of data of four different rehabilitation clinics from two different hospital companies (2699 and 2215 patients, respectively), aimed at possible predictors and outcomes of premature termination. We found ratios of premature termination of 8.3% and 14.7%, respectively. Especially young patients under 30 years of age and patients with eating and personality disorders were more likely to terminate inpatient treatment prematurely. Treatment outcome as rated by therapists was in significantly fewer cases among premature terminators than among successful terminators improved. The results seem to indicate, that assignment to inpatient psychotherapy can be optimized. For a better understanding of the process of premature termination more theory guided prospective and followup studies are necessary.

Adult↗

PubMed2000

Inpatient hospital admission through an emergency department in relation to stage at diagnosis of colorectal cancer.

The purpose of this study was to use population-based sources to estimate the frequency and characteristics of first inpatient hospital admission through an emergency department (ED) among 11,023 patients with diagnosed colorectal cancer between 1992 and 1996. Patients were identified from the population-based Connecticut Tumor Registry. Linkage with a statewide hospital discharge database (inpatient only) disclosed that 20% had a first hospital inpatient admission through an ED. Inpatient admission through an ED was statistically significantly associated with older age and race and was a statistically significant risk factor for distant stage at diagnosis. Studies are needed of the roles of patient delay and lack of screening in influencing ED presentation, especially in the elderly.

Admitting Department, Hospital↗

PubMed2001

Antimicrobial use and susceptibility rates in isolates from intensive care unit and other nosocomial inpatient and outpatient areas.

Our objective was to evaluate the relation between antimicrobial use and susceptibility in the intensive care unit (ICU) and non-ICU inpatient areas in the Bolzano regional hospital. For the isolates of S. aureus, coagulase negative staphylococci, Enterococcus sp., P. aeruginosa and E. coli we found a pattern of significant stepwise decrease in the frequency of antimicrobial susceptibility to penicilloic beta-lactam antibiotics and first generation cephalosporins; the highest senitivity rates occurred among isolates from outpatients, followed in decreasing order by rates among isolates from non-ICU inpatients and from ICU-patients; the rate of use of this group of antimicrobial agents was relatively high in the intensive care unit (13,1%). For P. aeruginosa we observed significantly lower susceptibility-rates to second, third and fourth generation cephalosporins, carbapenems and monobactams for non-ICU inpatient areas than for outpatient or ICU areas; this paralleled with the low use of this group of agents in the ICU area (4,9%). Also, for P. aeruginosa the prevalence of susceptibility to ciprofloxacin and norfloxacin in inpatient areas was lower than in the outpatient or ICU-areas; the rate of quinolone-use was relatively low in the ICU area (4,2%).

Ambulatory Care Facilities↗

PubMed2000

Association between administrative and ownership characteristics of hospices and their proportion of inpatient deaths.

Hospice patients are more likely to die at home than patients involved in conventional medical care, but the proportion of home deaths varies between programs. A study of the effect of hospice administrative characteristics on inpatient death rates is presented. Data from hospice programs that operated in New York State between 1993 and 1995 were obtained from the State Health Department and from publications of the National Hospice Organization. Inpatient death rates varied significantly between different operating structures: 11% for hospices that were divisions of home health care agencies; 34% for hospices that were divisions of hospital corporations; and 20% for hospices that were independent hospice corporations. This difference was explained by the presence of dedicated inpatient hospice units: Programs with such units demonstrated higher inpatient death rates than those without (42% versus 11%; P < .00001). Though not necessarily causal, these associations should be of interest to patients, physicians, families, and policy-makers.

Hospices↗