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PubMed1989

Diagnostic and psychopharmacological treatment characteristics of 536 inpatients with posttraumatic stress disorder.

Descriptive information (demographic variables, DSM-III diagnoses, and medications prescribed) was obtained from the discharge summaries of 536 male veteran inpatients who received a diagnosis of posttraumatic stress disorder (PTSD) over a 4-year period. Data comparisons were also made between two types of inpatient programs (specialized PTSD vs. psychiatric ward) to control for program selection biases. Consistent with previous studies, alcohol and substance abuse and/or depression diagnoses occurred concurrently with PTSD. Diagnoses of schizophrenia were more prevalent in the psychiatric wards. Nearly one third of the total sample received an axis II diagnosis, with borderline features most common. Half of all patients received psychopharmacological treatment in addition to psychotherapy. Antidepressants, neuroleptics, and beta-blockers were prescribed most frequently. Directions for future inpatient PTSD research are offered based on the findings.

Adult↗
PubMed2002

Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients.

This study has two purposes. The first purpose is to describe the severity of sexual abuse reported by a well-defined sample of borderline inpatients. The second purpose is to determine the relationship between the severity of reported childhood sexual abuse, other forms of childhood abuse, and childhood neglect and the severity of borderline symptoms and psychosocial impairment. Two semistructured interviews of demonstrated reliability were used to assess the severity of adverse childhood experiences reported by 290 borderline inpatients. It was found that more than 50% of sexually abused borderline patients reported being abused both in childhood and in adolescence, on at least a weekly basis, for a minimum of 1 year, by a parent or other person well known to the patient, and by two or more perpetrators. More than 50% also reported that their abuse involved at least one form of penetration and the use of force or violence. Using multiple regression modeling and controlling for age, gender, and race, it was found that the severity of reported childhood sexual abuse was significantly related to the severity of symptoms in all four core sectors of borderline psychopathology (affect, cognition, impulsivity, and disturbed interpersonal relationships), the overall severity of borderline personality disorder, and the overall severity of psychosocial impairment. It was also found that the severity of childhood neglect was significantly related to five of the 10 factors studied, including the overall severity of borderline personality disorder, and that the severity of other forms of childhood abuse was significantly related to two of these factors, including the severity of psychosocial impairment. Taken together, the results of this study suggest that the majority of sexually abused borderline inpatients may have been severely abused. They also suggest that the severity of childhood sexual abuse, other forms of childhood abuse, and childhood neglect may all play a role in the symptomatic severity and psychosocial impairment characteristic of borderline personality disorder.

Adolescent↗
PubMed1996

Characterization of an acute inpatient hospice palliative care unit in a U.S. teaching hospital.

An existing hospice palliative care inpatient unit was studied from September 1993 to November 1993 to characterize it for two qualities: demographics of admitted patients and family satisfaction after discharge. The purpose of this study was to identify current uses of the unit and determine whether the high level of satisfaction among family members, as perceived by the staff, was accurate. To characterize demographics, 100 consecutive admissions to the unit were assessed prospectively beginning in September 1993. To characterize family satisfaction, a survey was sent to the families of 240 patients who had been cared for on the inpatient unit. Since this study, it has been identified that care on the hospice palliative care unit is provided at a 50% reduction in daily hospital charges. The hospital has benefited from establishing and maintaining an acute care inpatient hospice palliative care unit. Other academic medical centers in the United States should consider a designated unit for symptom management and terminal care as part of their comprehensive range of healthcare services.

Adult↗
PubMed2000

Patients with recognized psychiatric disorders in trauma surgery: incidence, inpatient length of stay, and cost.

BACKGROUND: Although psychiatric disturbances are highly prevalent among traumatically injured inpatients, few investigations have assessed the impact of these disorders on surgical length of stay (LOS) and cost. METHODS: The authors identified all trauma-registry recorded psychiatric diagnoses among patients admitted to University of California Davis Medical Center between January 1993 and December 1996. Linear and logistic regressions were used to assess the unique effects of psychiatric diagnoses on inpatient LOS and cost. RESULTS: A total of 29% of patients had one or more registry-recorded psychiatric diagnosis. Patients with alcohol abuse diagnoses demonstrated 10% to 12% decreases in LOS and cost (p < 0.01), whereas patients with stress disorders, delirium, and psychoses demonstrated 46% to 103% increases in LOS and cost (p < 0.01). CONCLUSION: Patients with recognized psychiatric disorders uniquely impact inpatient trauma surgery LOS and cost. Additional investigations of the processes and outcomes of care could lead to cost-effective performance improvement efforts that target the amelioration of comorbid psychiatric disorders among physically injured trauma survivors.

Adolescent↗
PubMed1981

Effect of hospital-based primary care setting on internists' use of inpatient hospital resources.

Hospital-based primary care is expanding, yet the impact of the hospital setting on physician practice patterns and health care costs is unknown. This project compared the use of inpatient hospital resources between internists practicing in hospital-based and freestanding primary care clinics. All hospitalizations over a two-year period by internists in the Kaiser-Permanente Medical Care Program--Oregon Region were analyzed ( n = 5,623). Organizational and financial incentives were uniform for all internists. Results indicate that hospital-based internists use inpatient resources differently from other internists. The former are more likely to hospitalize, but their patients are likely to have a shorter length of stay and fewer laboratory tests or consultations. On average, the hospital-based internists used 44 more hospital days for every 1,000 doctor office visits than did other internists, suggesting the policy makers need to consider the influence of the hospital setting on the level of inpatient utilization. Further research on the causality of this relationship and its generalizability appears a strong priority.

Ambulatory Care Facilities↗
PubMed1998

Impact of an all-inclusive diagnosis-related group payment system on inpatient utilization.

OBJECTIVES: Although case-based payment is one of the main reimbursement mechanisms for hospitals, little is known about its effects in the general population. Prior studies have focused on Medicare or on all-payer systems in particular states. This study estimates the effect of a prospective payment system based on diagnosis-related groups (DRGs) nationwide in the Department of Veterans Affairs. METHODS: Multiple regression analysis was used to estimate the effect of Department of Veterans Affairs's diagnosis-related group system separately for 22 diagnoses. The dependent variables were length of stay, inpatient days per patient, and discharges per patient. Covariates included patient, hospital, and area characteristics. RESULTS: Department of Veterans Affairs's diagnosis-related group system reduced lengths of stay and inpatient days per patient. The largest impacts were for the psychiatric diagnoses and several surgical procedures. The magnitudes of the effects were generally moderate. Department of Veterans Affairs's case-based system had a negligible effect on discharges per patient. CONCLUSIONS: Per case reimbursement is a potentially useful tool for improving the efficiency of inpatient care for all types of diagnoses and age groups. The effect may be larger than estimated here because of institutional barriers and caps on financial impact.

Aged↗
PubMed1994

Follow-up survey of inpatients with AIDS and HIV infection: economic impact on hospitals in North Carolina.

This study is a 2-year follow-up to a 1987-1988 survey of North Carolina hospitals regarding hospital utilization by patients with acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection. Almost 99% of the state's hospitals participated in the re-survey for the fiscal year 1989-1990. The number of general hospitals treating these patients grew by 57%; HIV/AIDS inpatients increased by 189% from 540 to 1,561. Total general hospital charges for HIV/AIDS inpatients increased from $7,685,000 to $26,957,000, an increase of 251%. Of these charges the amount that was uncompensated by insurance increased by 293% to $7,733,000. Fifteen large tertiary general hospitals treated 80% of the HIV/AIDS inpatients and accounted for $6,093,000 (79%) of the uncompensated charges related to these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Occupational exposures and diseases among medical inpatients. Prevalence, association, and recognition.

The purpose of this study was to identify the prevalence of occupational exposures, their potential contribution to the development of chronic diseases among medical inpatients, and their recognition by house officers. Occupational histories were obtained from 101 medical inpatients and their charts were reviewed. Sixty-six percent of patients had diseases for which an occupational etiology merited consideration. A relevant occupational exposure was discovered in 68% of patients with a disease potentially attributable to occupation. Specific disease/exposure pairs were associated with each other (P = .001). Senior house staff recognized fewer relevant exposures (17%) than did interns (55%) (P < .001). Relevant occupational exposures are common among medical inpatients, but frequently go unrecognized because of an inadequate fund of knowledge in occupational medicine among physicians.

Adult↗
PubMed2006

A wellness class for inpatients with psychotic disorders.

OBJECTIVE: The purpose of this project was to educate inpatients with psychotic disorders, many of whom were taking second-generation antipsychotics, about lifestyle changes they can make to combat weight gain. METHOD: All inpatients on a Veterans Affairs acute inpatient schizophrenia treatment unit were invited to a 30-minute, didactic presentation given by a medical student and a psychology student under the supervision of the primary investigator. The topics covered included the health benefits of maintaining an ideal body weight by selecting foods according to the USDA Food Pyramid, determining adequate food portions, choosing healthy meals outside the home, and beginning and adhering to an exercise program. Subjects completed a 13-item quiz concerning their knowledge of food and nutrition before and after the presentation to determine its efficacy in teaching patients the material. RESULTS: Fifty patients completed both the pre- and post-presentation tests. The mean percentage of correct answers on the pre-test was 85.6%, which rose to 89.3% on the post-test. This difference of 3.7% was statistically significant (t = 2.43, df = 49, p < 0.02), and the mean percent of improvement was 6.1%. CONCLUSIONS: This study demonstrates that psychotic individuals are able to benefit from educational presentations about nutrition and a healthy lifestyle. A statistically significant improvement in test scores suggests that subjects gained an understanding of basic concepts related to food choices and fitness.

Adult↗
PubMedDate not supplied

Impact of an inpatient rehabilitation facility on functional outcome and length of stay of burn survivors.

This study reviewed the use of an inpatient rehabilitation unit for burn survivors. We hypothesized that adult burn patients admitted earlier to inpatient rehabilitation have an equal or better functional outcome than those remaining in acute burn center for rehabilitation care. Functional Independence Measure (FIM) data were prospectively collected on our burn center admissions dating January 2002 to August 2003. National rehabilitation data were acquired from eRehabData and burn literature. A total of 217 adult patients survived until hospital discharge, with 21 (9.7%) discharged to inpatient rehabilitation (REHAB). REHAB had larger burn injuries, more inhalation injuries, higher incidence hand/foot burns, and longer length of stay (LOS). REHAB had lower FIM upon rehabilitation facility admission than national averages but greater FIM improvement during comparable rehabilitation LOS. Although our earlier rehabilitation admission strategy results in more frequent rehabilitation unit referrals, patients had shorter burn center LOS and greater FIM improvement compared with limited national burn patient functional outcome data currently available.

Activities of Daily Living↗
PubMed2006

Unforeseen inpatient mortality among veterans with schizophrenia.

BACKGROUND: Patients with schizophrenia have co-occurring medical conditions, like other patients, but may lack the capacity to provide good self-care or to work with their providers to ensure appropriate medical treatment. We hypothesized that death among patients with schizophrenia occurs more frequently after minimal care of comorbid conditions. METHODS: All patients who died in veterans affairs (VA) hospitals during FY02 were categorized as to type of death: unforeseen (age <80 years, 1-2 inpatient days past year), cancer, organ failure (heart, lungs, kidneys), frailty (dementias, hip fractures, dehydration, etc.), or other deaths. Logistic regression explored factors in unforeseen death. RESULTS: During the year, 27,798 patients died in VA facilities; 3% had schizophrenia (n = 943). Roughly two-thirds of all deaths were from cancer or organ failure, 11% frailty, 9% other, and 8% met criteria for unforeseen death. Among patients with schizophrenia, however, 20% fell into the unforeseen death category. In an adjusted model, schizophrenia was associated with a 2-fold increased risk of unforeseen death compared with any other category (odds ratio = 2.4, 95% confidence interval 1.6-3.4). Unforeseen death was less likely among patients with substance abuse diagnoses in the year before death and more likely when patients had no outpatient medical care. CONCLUSIONS: VA patients with schizophrenia were more likely to die as inpatients with little previous-year care compared with other inpatient decedents without schizophrenia. Outreach efforts may be necessary to engage patients with schizophrenia in treatment of potentially life-threatening conditions.

Adult↗
PubMed2004

Depression in France and Brazil: factorial structure of the 17-item Hamilton Depression Scale in inpatients.

Among various research strategies for depression, the cross-cultural approach is a useful tool to investigate depressive disorders. The Hamilton Rating Scale for Depression was applied to 130 depressed inpatients in France and Brazil. Items were factorized by principal component analysis with Varimax rotation using the Kaiser or simulation method for factor sorting. Three factors were obtained in France, and four in Brazil. The first factor includes the core symptoms of depression in both samples. Qualitative and quantitative differences appeared in the anxiety factor between Brazilian and French samples. Insomnia items appeared as another factor for both groups. A limitation of this study is that it was conducted with small inpatient samples. Principal component analysis of the Hamilton Rating Scale for Depression for depressive inpatients in these two countries showed a similar structure. Differences observed were in the way anxiety items were distributed.

Adult↗
PubMed2005

Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness.

The purpose of this study was to assess the utility of social cognition and insight in the prediction of violence in a psychiatric inpatient sample. Violence history, demographic information, symptomatology, neuropsychological functioning, social cognition (i.e., attributional style), and insight were assessed in 29 inpatients with severe mental illness. Greater posttest violence was associated with greater pretest violence, less education, greater psychiatric distress, neuropsychological impairment, and hostile attributional and personalizing biases. Hierarchical multiple regression analyses showed that history of violence contributed the most variance to posttest violence. Hostile attributional and personalizing biases were also uniquely associated with posttest violence. Overall, this study supported the modest utility of attributional style measures in the prediction of inpatient violence. The predictive value of insight in this context appears limited.

Adult↗
PubMed2004

Pediatric observation status beds on an inpatient unit: an integrated care model.

OBJECTIVES: Describe the usage of observation status (OS) beds on a pediatric inpatient unit and identify diagnoses likely to be successfully discharged compared to those requiring formal inpatient admission. METHODS: Retrospective chart review of all patients (0-18 years) transferred to pediatric OS beds from the emergency department (ED) between April 1, 1997 and April 30, 1999. Outcome measures consisted of time interval between ED triage and arrival to an OS bed, total hours in observation, and need for admission or transfer. Using relative risk (RR), we compared admission rates for the 4 most common diagnoses. RESULTS: We studied 800 transfers to pediatric OS beds. Asthma (27%), gastroenteritis/dehydration (16%), infectious disease (12%), and bronchiolitis (9%) were the 4 most common diagnoses. There were 597 patients (75%) successfully discharged from observation and 174 (22%) required inpatient admission. Seventeen patients (2%) were transferred to a psychiatric facility and 12 patients (1%) were transferred to a tertiary care center for further evaluation and treatment. Compared to gastroenteritis/dehydration, patients with asthma were just as likely to be admitted/transferred (RR 1.05, 95% CI, 0.87-1.27), those with an infectious disease were 1.3 times more likely to be admitted/transferred (RR 1.35, 95% CI, 1.0-1.83), and those with bronchiolitis were 2 times more likely to be admitted/transferred (RR 1.92, 95% CI, 1.34-2.74). CONCLUSIONS: We describe the usage of OS beds in a community hospital that we believe can be a successful model for the care of pediatric patients. Future studies are needed to delineate the clinical characteristics of patients that would benefit from this care delivery model.

Asthma↗
PubMed2005

Acute inpatient rehabilitation of 55 patients after liver transplantation.

OBJECTIVE: Acute rehabilitation for patients who have had liver transplants is often necessary to restore functional mobility, but no studies, except for case reports, have documented the complications, outcomes, or predictors of success of an acute inpatient rehabilitation program. Our objective was to examine each of these areas related to rehabilitation after liver transplantation. DESIGN: We performed a chart review of 55 patients who received a liver transplant and were treated on our acute rehabilitation service. We examined several factors, including age, reason for transplant, length of acute hospital stay, length of acute inpatient rehabilitation stay, FIMtrade mark scores, albumin levels, medical complications, and discharge disposition. RESULTS: Patients undergoing rehabilitation after liver transplantation required multiple medical interventions, including liver biopsy, ultrasound, blood transfusions, and dialysis. Several patients (15%) were transferred to the acute care hospital for medical problems. Both a low albumin and a long length of stay in the acute care hospital correlated with a longer stay in rehabilitation and less efficient rehabilitation. Longer rehabilitation stays correlated positively with FIM gain (P < 0.001, r = 0.534). Significant improvements in FIM scores (P < 0.001) during acute inpatient rehabilitation were noted in patients who were discharged to home. We also found that age, albumin level, and length of stay in the hospital did not predict discharge disposition. CONCLUSION: Patients who have had liver transplants can achieve significant functional gains in acute rehabilitation. Rehabilitation professionals should be aware of potential complications and factors that may affect the rehabilitation of this patient population.

Activities of Daily Living↗
PubMed2006

Early unplanned transfers from inpatient rehabilitation.

OBJECTIVE: To identify characteristics of patients who transfer off inpatient rehabilitation to a surgical or medical unit before completion of their rehabilitation program. DESIGN: A retrospective 9-yr chart review of patients transferred off the rehabilitation unit at a regional level 1 trauma center due to medical complications. RESULTS: Of 3072 patient admissions, 250 (8%) were transferred to an acute medical or surgical unit, and 55 (22%) of those transfers were within 3 days. Of the 250 patients, 33% had traumatic brain injury, 23% had spinal cord injury, 24% had stroke, 2% had amputations, 18% were in other diagnostic groups, and 23% were >64 yrs of age. When patients transferred early, only 47% were ultimately discharged to home, compared with approximately 72% of all discharges. The most common reasons for early transfer in these patients were infection (22%) and pulmonary complications (14%). Risk factors for early discharge included age of >64 yrs, spinal cord injury, or amputation. CONCLUSION: Patients admitted to the inpatient rehabilitation unit who have spinal cord injuries, amputations, or are >64 yrs old may have more medical/surgical complications. More detailed study of this patient population may help reduce the number of early transfers off the inpatient rehabilitation unit.

Adolescent↗
PubMed2006

Falls sustained during inpatient rehabilitation after lower limb amputation: prevalence and predictors.

OBJECTIVE: The purpose of this study is to identify risk factors for falling and fall-related injury among a group of inpatients undergoing rehabilitation after major lower limb amputation. DESIGN: Retrospective cohort. RESULTS: Out of 1267 patients, 260 (20.5%) fell at least once. There were a total of 374 falls, 67 (17.9%) of which resulted in one or more injuries. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated for factors significantly associated with falling, including age of > or =71 yrs (OR = 1.40, 95% CI = 1.02-1.89), lengths of stay of 22-35 days (OR = 2.97, 95% CI = 1.14-7.72) or >5 wks (OR = 6.07, 95% CI = 2.34-15.71), four or more comorbidities (OR = 1.93, 95% CI = 1.09-3.41), cognitive impairment (OR = 1.68, 95% CI = 1.02-2.78), two or more as-needed medications (OR = 1.81, 95% CI = 1.02-3.21), benzodiazepines (OR = 2.22, 95% CI = 1.24-3.96), and opiates (OR = 5.76, 95% CI = 3.29-10.09). Factors significantly associated with fall-related injuries included bilateral amputation (OR = 3.68, 95% CI = 1.49-9.05) and falls during the day shift (OR = 2.63, 95% CI = 1.24-5.57). CONCLUSIONS: One in five patients with lower limb amputation will likely experience at least one fall during inpatient rehabilitation, with 18% sustaining an injury. Ongoing research is required to develop appropriate intervention strategies to ameliorate the risk of falling during inpatient rehabilitation.

Accidental Falls↗
PubMed2006

Injury hospitalizations: using the nationwide inpatient sample.

BACKGROUND: The aims of this study are to develop estimates of discharge rates and frequencies for all injury-related hospitalizations in the United States for the year 2000 and to characterize patterns of hospitalized injury and anatomic region using a modified Barell Matrix. The utility of the Nationwide Inpatient Sample (NIS) for providing national estimates of hospitalized injuries will be discussed. METHODS: This study is a retrospective analysis of hospital discharge data using the Nationwide Inpatient Sample. All hospital discharges with a primary diagnosis of injury were selected. Total number of hospitalizations, annual discharge rates, and 95% confidence intervals were calculated by body region, nature of injury, and injury mechanism. Number of injuries by age, sex, body region, and nature of injury were also calculated for falls and motor vehicle crashes. RESULTS: In 2000, there were an estimated 1,690,780 hospital discharges with a primary injury diagnosis. Discharge rates were highest for the oldest age groups. Falls and motor vehicle crashes were the leading causes of hospitalization. Fracture was the most common diagnosis and lower extremity injury was the most common anatomic region. CONCLUSIONS: Hospital discharge data adds another dimension to our understanding of the total injury burden. The Nationwide Inpatient Sample may be useful in providing national estimates of hospital discharges.

Accidental Falls↗