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PubMed1999

Comparison of substance abuse treatment outcomes for inpatients and outpatients.

This study was conducted to determine whether inpatient substance abuse treatment was associated with higher posttreatment abstinence rates than outpatient treatment. The follow-up sample of 2,476 adults represented 183 Minnesota treatment programs. Composite measures were constructed based on psychometric analyses of a modified version of the Addiction Severity Index and additional variables. A series of analyses was conducted, including hierarchical logistic regression and a contingency table analysis addressing multiple problem severity. For the total sample, setting was not significantly associated with abstinence once other outcome predictors and differences between inpatients and outpatients were controlled for. However, when the logistic regression analysis was extended to include all possible two-way interactions of setting with clinically related severity variables, recent suicidal behavior was found to be a moderator of the association between setting and outcome. Inpatient treatment significantly predicted a higher posttreatment abstinence rate than outpatient treatment for the small subset of patients (16% of the sample) who reported recent suicidal ideation or attempt.

Adult↗
PubMed2003

Accuracy of the continuous glucose monitoring system in inpatient and outpatient conditions.

OBJECTIVE: To evaluate in inpatient and outpatient conditions, using only non-calibration data, the accuracy of the Continuous Glucose Monitoring System (CG-MS). RESEARCH DESIGN AND METHODS: Twelve, 21 and 20 type 1 diabetic patients participated in 3- day inhospital, 6-day ambulatory (i.e., 2 sensors worn consecutively) and 3-day ambulatory studies. Capillary glucose tests (7-8/day) served as comparisons. Pairs of data (excluding the 4 daily pairs used automatically by the CGMS for calibrations) were analyzed using correlation coefficient, error -grid analysis, and mean of absolute differences. RESULTS: Two third and half of the sensing days were qualified as "optimal", i.e., interpretable by the CGMS program in the inpatient and outpatient studies, respectively. Correlation coefficient was 0.92, 0.81 and 0.73 in the inpatient, 6 day outpatient and 3-day outpatient studies. 98%, 93% and 96% of the data fell in the A or B error-grid "clinically acceptable" zones. Mean absolute differences between sensor and glucometer values were 25 +/- 2, 34 +/- 5 and 32 +/- 5 mg/dl. CONCLUSION: CGMS may be used for assessment of glycemic trends, though accuracy is more in the range of glucometers than of laboratory tests. Inhospital utilisation improved accuracy and 6-day rather than 3-day sessions may be more appropriate to evaluate day to day reproducibility of glucose profile.

Automation↗
PubMed2004

Inpatient-outpatient cost shifting in Washington hospitals.

This paper empirically investigates the phenomenon known as "cost shifting" across inpatient and outpatient hospital services. That is, we examine whether, when faced with lower government reimbursement for outpatient services, providers raise inpatient prices for non-government patients (and analogously for lower inpatient government reimbursement). Using a panel of hospitals from Washington State, we find that private, nonprofit hospitals do cost shift across types of services. We also find that a firm's cost shifting behavior differs based on the type government insurance program (i.e., Medicare versus Medicaid). Government owned hospitals do not cost shift with respect to any type of government insurance plan.

Cost Allocation↗
PubMed2003

[Effects of hip arthroplasty followed by by inpatient rehabilitation on physical function and quality of life].

The aim of the present study was to investigate the effects of hip arthroplasty followed by an inpatient rehabilitation. Moreover, the relationships among functional status, quality of life and satisfaction with life or health status were examined. Patients were assessed before hip arthroplasty, at the start and at the end of the inpatient rehabilitation. Functional status was measured by using the WOMAC questionnaire and quality of life with the Medical Outcome Survey Short Form 36 (SF-36). Satisfaction was determined with a specific questionnaire (FLZ). Hip arthroplasty followed by an inpatient rehabilitation resulted in significant and clinically highly important improvements of functional status, quality of life and satisfaction with health and life.

Adult↗
PubMed2005

Long- and short-term risk factors in the prediction of inpatient suicide: review of the literature.

The prediction of suicide remains a major challenge for health care professionals in inpatient settings. A clearer identification of factors specific to inpatient suicide is required to improve both practice and research within this area. This paper provides an overview of the inpatient suicide literature to date focusing on two particularly salient themes: Long term and short term prediction of suicide. Since the concept of short-term suicide risk dominates clinical practice, issues in relation to dynamic risk factors are emphasized.

Comorbidity↗
PubMed2002

Prediction of inpatient violence.

OBJECTIVE: An overview of studies on predictors and on the accuracy of prediction of inpatient violence should be given. METHOD: To date, the published data do not allow a systematic meta-analysis due to different sample characteristics, different measures and definitions of violence, and different time frames of observation. Published studies were reviewed regarding significant predictors of inpatient violence. RESULTS: Predictors of violence in institutional settings are different from predictors of violence in the community: variables such as sex, age, diagnosis and alcohol abuse play a minor role, while clinical and psychopathological variables are prominent. Only history of violence is a robust static predictor. The total level of positive and general psychotic symptoms seems to enhance the violence risk of inpatients, whereas results concerning specific features like delusions or command hallucinations are contradictory due to inevitable problems of sample selection. The accuracy of clinical predictions is better than chance but limited by the effects of therapeutic interventions and research artefacts. CONCLUSION: The author argues that more precise determinations of the violence risk in institutions will fail and that the role of environmental factors has often been underestimated.

Humans↗
PubMed2000

A comparison of inpatient and outpatient ASCT.

Outpatient high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to be feasible in terms of physical morbidity and mortality outcomes, but few data exist on the psychosocial impact of delivering such aggressive therapy in this manner. The purpose of this observational study was to compare effects of inpatient (n = 20) and outpatient (n = 21) modes of care on physical status, psychological well-being, quality of life, personal finances and caregiver burden. Most patients were treated according to their preference for inpatient or outpatient care. Those choosing outpatient care were screened for eligibility according to established criteria for ambulatory management. Measures were taken at baseline, then at days 4-6, 12-16 and 30 post ASCT. Results showed that overall, the psychological, physical, social and financial outcomes of the outpatient ASCT group were comparable, to or better than inpatients. Factors that seem to be important for successful outpatient management are previous experience with cancer treatment, a satisfying quality of life, physical well-being, patient's preference for a particular mode of care and physical proximity to the treatment centre. The study results suggest that outpatient ASCT is an efficient, effective and acceptable form of care for motivated patients and caregivers who have the physical and psychological capability and desire to receive cancer treatment in this manner.

Adult↗
PubMed2002

The resources of parents with a child in psychiatric inpatient care.

The purpose of this study was to analyse and describe the resources of parents with a child in psychiatric inpatient care. The factors associated with parental coping were also assessed. The data were collected from 19 hospitals with a child psychiatry unit. At the time of data collection, all the parents of the children in psychiatric inpatient care in these hospitals were invited to participate in the study (N = 268). The method of data collection was a questionnaire including open-ended questions. The response percentage was 30% (N = 79). The data were analysed using SPSS software. The replies to the open-ended questions were analysed utilizing data-based content analysis. The findings indicated that the parents received more emotional than instrumental support. Few got financial support. The parents got support from their spouses, families, friends and fellow-workers and the health care personnel. Nearly half of the parents wanted more support from health care personnel. Of the different kinds of social support reported, emotional support, support in the care and rearing of the child in inpatient care, love and acceptance correlated most strongly with parental coping.

Adaptation, Psychological↗
PubMed2001

Factors associated with the coping of parents with a child in psychiatric inpatient care.

The purpose of this study was to establish the parental coping' factors associated with having a child in psychiatric inpatient care. The data were collected from 19 hospitals with child psychiatry units. At the time of data collection, all parents of children in psychiatric inpatient care in these hospitals were recruited. The method of data collection was a questionnaire (n = 79). The data were analysed with the Statistical Package for the Social Sciences (SPSS) for Windows statistical software. The connections between variables were studied with cross-tabulation, and the chi2 test was used to determine significance. Changes in internal and external family relationships and matters related to the upbringing of the child with mental problems statistically correlated significantly with parental coping (P < 0.001). Problem-oriented and emotionally-oriented coping strategies, skills and palliative strategies correlated significantly with parental coping (P < 0.001). Emotional support, support for the care and upbringing of the child in inpatient care, and love and acceptance also had statistically significant associations with parental coping (P < 0.001).

Adaptation, Psychological↗
PubMed2001

Reducing hospital inpatient length of stay for patients with diabetes.

AIMS: To ascertain the effect of routine review by a diabetes nurse advisor on length of stay for medical and surgical inpatients with diabetes. METHODS: Inpatients with diabetes were identified prospectively from January 1997 until December 1998 (792 in 1997 and 819 in 1998). A new post of diabetes nurse advisor was introduced in January 1998 to optimize diabetes management. Length of stay was calculated retrospectively from hospital computer records. RESULTS: Median length of stay in 1997 was 11 days in medicine and 8 days in surgery. In 1998, the nurse advisor made 1936 visits to 819 patients; median length of stay fell to 8 days in medicine and 5 days in surgery (P < 0.001). Bed occupancy by patients with diabetes fell from 6.8 to 4.0%. Mean length of stay across the hospital remained unchanged. CONCLUSIONS: The introduction of a ward-based diabetes nurse advisor was associated with significant reductions in length of stay in inpatients with diabetes. Since this study was not a randomized study, other factors may have contributed to this change. However, the consistency of the reduction across specialities suggests the post itself had an important effect.

Diabetes Mellitus↗
PubMed2002

Functional outcome after inpatient rehabilitation in persons with subarachnoid hemorrhage.

OBJECTIVES: To describe inpatient rehabilitation outcome in persons with nontraumatic subarachnoid hemorrhage (SAH) and to explore the predictive capacity of acute measures of SAH severity and demographic and disease variables. DESIGN: Retrospective with descriptive and relational analyses. SETTING: Free-standing, acute, inpatient brain injury rehabilitation unit. PARTICIPANTS: Forty-two consecutive persons with nontraumatic SAH and for whom complete data were available were studied. Mean age of the group was 56.5 years, mean acute hospital stay was 26.2 days, and 60% were women. Over 40% experienced rupture of an anterior communicating artery aneurysm. The time from injury to rehabilitation admission varied from 11 to 227 days (mean, 43.8d). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Change in FIMtrade mark instrument scores, home discharge rate, and rehabilitation length of stay (LOS.) RESULTS: The mean admission and discharge FIM scores were 57.7 and 85.5 points, respectively. There was a 27.8-point mean change in FIM score over a 24.1-day mean rehabilitation LOS for a FIM efficiency (points/day) of 1.15. Over 80% of the sample was discharged home. No demographic or disease characteristic variables, including acute severity measures, were statistically significant predictors of outcome. CONCLUSIONS: Functional gains during inpatient rehabilitation made in this group of 42 persons with SAH are in line with earlier studies. Our rehabilitation LOS is the shortest reported among 4 studies to date and is probably a reflection of managed care in the United States. A small sample, uneven cell sizes, and variability of patients might have contributed to a lack of significant findings. Future study should explore the prediction of rehabilitation outcome using larger sample sizes and longer follow-up periods.

Adult↗
PubMed2001

[Psychiatric inpatient length of stay. An overview of methods, influences and consequences].

Duration of inpatient psychiatric treatment is considerably under discussion between hospitals and payers. This article aims at reviewing the scientific evidence on the topic of psychiatric inpatient duration of stay. Two general research questions can be identified from the literature: 1. Which factors do influence duration of stay? 2. Which consequences does duration of psychiatric treatment have on patients' health status? Results show that duration of stay is less influenced by psychiatric diagnosis and sociodemographic items but more by the process of treatment and by organizational characteristics of the institutions. More recent studies generally find positive effects of longer treatment episodes. Studies about the consequences of duration of stay show a relation between reductions in duration of treatment and increasing readmissions. It is concluded that reductions in duration of inpatient treatment must be carefully evaluated to prevent negative consequences for patients' health status.

Health Status↗
PubMed2004

[Criteria of quality of structure in rehabilitation units with inpatient treatment].

The structure of a rehabilitation unit is an important feature of the quality of care. Adequate and qualitatively good structures provide the basis for appropriate therapy offers and treatment and eventually, a better health for rehabilitants. The quality of structures is generally recorded without any evaluation of the aspects in particular. The definition of standards is the basis for such an evaluation. The project presented is aimed at the definition of relevant structural standards for rehab units with inpatient treatment for musculoskeletal, cardiac, neurological, gastroenterological, oncological, pneumological and dermatological diseases. Here, the distinction between basal criteria which have to be fulfilled by every rehab unit with inpatient treatment and criteria important for a well-aimed assignment of patients with specific needs ("assignment criteria") should be made. Apart from the documentation of structural attributes, the structural quality of a rehab unit can be described individually as well as in comparison with other units. Relevant structural criteria were defined in expert meetings by means of a modified Delphi-technique with five inquiries. Overall, 199 "basal criteria" and "assignment criteria" were defined. All criteria can be assigned to the two domains general structural characteristics (general characteristics and equipment of rooms; medical/technical equipment; therapy, education, care; staff) and process-related structures (conceptual frames; internal quality management; internal communication and personnel development). The structural standards are applicable to units for musculoskeletal, cardiac, neurological, oncological, gastroenterological, dermatological and pneumological rehabilitation financed by the two main providers of rehabilitation, the statutory pension insurance scheme and the statutory health insurance scheme for all other five indications. The definition of structural standards agreed by experts in a formal consensus process, provides comprehensive and concrete requirements for German rehab units with inpatient medical rehabilitation. If the two main providers of rehabilitation both use the standards this can be regarded as a hallmark on the path to a unitary programme for quality management. The results enable units to analyse their weak points not just on an individual basis but allow also for a comparison between units, along with contributing to optimizing the structural quality of rehab units.

Germany↗
PubMed2005

[Health service aspects of psychosomatic inpatient treatment in a general hospital].

The study objective is to outline basic aspects of medical care service structure in the fields of psychosomatic medicine in a clinical acute-care setting. A total of 216 inpatients in a psychosomatic ward of a general hospital were investigated during a 32 months period using a retrospective study design. Referring physicians and clinics along with referral procedures, the waiting period, teamwork with other clinics, as well as patient and therapy characteristics are described. According to provisions of outpatient psychosocial care, general practitioners refer the majority of the inpatients (55 %), followed by other clinics (25 %) and psychosomatic and psychiatric outpatient specialists (20 %). An outpatient department along with a psychosomatic C-L service are key elements for a psychosomatic department to ensure coordination of the referral procedure. The average waiting period lasts 21 days, the average length of stay is 48 days. 60 % of the inpatients show somatic and psychiatric co morbidity. A psychopharmacological treatment has to be taken into consideration along with multi-modal psychotherapy in a third of all patients.

Adolescent↗
PubMed1988

The effects of regulation, competition, and ownership on mortality rates among hospital inpatients.

We examined the influence of the regulation of hospital rates, state certificate-of-need programs, competition, and hospital ownership on mortality rates among inpatients receiving care under Medicare for 16 selected clinical conditions that were studied as a group. Data were obtained from the records of 214,839 patients who received care in 981 hospitals in 45 states from July 1, 1983, through June 30, 1984. We found significant associations between higher mortality rates among inpatients and the stringency of state programs to review hospital rates (P less than or equal to 0.05), the stringency of certificate-of-need legislation (P less than or equal to 0.01), and the intensity of competition in the marketplace, as measured by enrollment in health maintenance organizations (P less than or equal to 0.05). Hospitals in the states with the most stringent review procedures for hospital rates had ratios of actual to predicted death rates that were 6 to 10 percent higher than those of hospitals in states with less stringent rate-review programs (P less than or equal to 0.001). Hospitals in the states with the most stringent procedures for reviewing applications for certificates of need had ratios of actual to predicted death rates that were 5 to 6 percent higher than those of hospitals in states with less stringent certificate-of-need procedures (P less than or equal to 0.05). There was no statistically significant association between mortality rates among inpatients and either the type of hospital ownership or the number of hospitals competing in the market area. Additional analyses, which examined alternative explanations for these findings, failed to change the results. These findings raise serious concerns about the welfare of patients who are admitted to hospitals in highly regulated areas and those admitted to hospitals in relatively competitive markets. They suggest that it is important to incorporate quality-assurance procedures and systems to monitor patients' outcomes into public and private programs designed to contain costs or promote competition, or both.

Aged↗
PubMed2003

Inpatient hospital care for psoriasis: a vanishing practice in the United States.

BACKGROUND: Inpatient hospital care was a traditional approach to treat severe psoriasis. Since 1980, only modest innovations in psoriasis therapy have been introduced, but regulation and financing of inpatient hospital care have changed greatly. OBJECTIVE: We documented changes in the use of inpatient care in acute care hospitals for psoriasis in a cohort of individuals with severe psoriasis and nationally. METHODS: Using interviews, we quantified hospitalizations for psoriasis and other reasons among the PUVA Follow-up Study cohort. We used National Hospital Discharge Survey data to determine national trends in hospitalization rates. RESULTS: In 2 decades, national rates of hospitalization primarily for psoriasis decreased more than 80%. Among our cohort of persons with severe psoriasis, the age-adjusted rate of hospital days for psoriasis decreased more than 60% during this period. CONCLUSION: Currently, hospitalization in acute care hospitals is seldom used to care for persons with psoriasis.

Adult↗
PubMed2000

Assessing the relationship between inpatient and outpatient activity: a clinical specialty analysis.

General and specialist services in public acute hospital outpatient departments play a key role in the health care system and represent a vital interface between inpatient and community care. Typically outpatient services involve millions of patient visits within a very short time frame and in Victoria alone between 8-10 million outpatient occasions of service are provided each year. Drawing on the first full year of data from the Victorian Ambulatory Classification System (VACS) this paper examines the patterns underlying the distribution of inpatient separations and outpatient encounters at 16 major Victorian public hospitals and assesses the relationship between inpatient and outpatient activity at the clinical specialty level.

Ambulatory Care↗
PubMed1996

Termination in inpatient groups.

This article provides the therapist with a three-factor framework for understanding and constructively responding to members' termination in the inpatient group. The first factor is the context in which the inpatient group takes place. It will be argued that how the broader system defines and treats termination affects the group process at the time of termination. The second factor is the therapist's countertransference. Three especially common reactions (disappointment, abandonment anxiety, and powerlessness) will be described. The third factor is the characteristic need of inpatients at termination time. Each factor is described in terms of its potential impact on the termination process. Techniques and suggestions are offered that aim to mitigate the destructive forces of each factor and to enhance the therapeutic value of the termination event for the patient.

Countertransference↗