Regional variation in patterns of inpatient psychiatric care

Article Abstract:

Regional variations in inpatient psychiatric care have been previously reported, with numbers of occupants and duration of stay varying the most between the Northeast and Western regions of the country. Even among Veterans Administration (VA) facilities, which have centralized policies and are more homogenous, variations have been noted. Because the cost and quality of health care are important issues, it is essential to understand the basis of these variations so standards can be set. This report obtained data from the 1983 National Institute of Mental Health survey of mental health care organizations around the country. Significant differences were found in the average length of stay for each episode of care across the seven national regions (Pacific, Mid-West, Southwest, North Central, Northeast, Mid-Atlantic, and Southeast). This included significant differences between the Mid-Atlantic and Northeast regions, and the Mid-West, Pacific, and Southwest regions. The longest stays occurred in the Northeast and Mid-Atlantic regions, where averages were 20 percent higher than the rest of the nation. The shortest stays occurred in the Mid-West, Pacific and Southwest regions. The Northeast and Mid-Atlantic regions also had the highest number of occupied beds per 100,000 population, and the Pacific and Southwest had the fewest. Regions with the highest number of occupied beds also had the shortest stay durations, two facts that are probably related. Among the non-VA facilities, state and county hospitals showed the greatest regional differences, the private hospitals showed little variation, and the nonfederal general hospitals showed virtually no differences. The VA and non-VA facilities showed very similar regional variations; these variations were noted in general medical facilities as well. Private and nonfederal facilities seemed less affected by these trends, maybe because of their ability to select their patient population, referring the rest to public facilities. A plausible explanation is that the needs of the chronically ill are so great that if funding is available, the stays will be longer. It is also suggested that in some western states where community care networks are extensive, fewer hospital beds may be needed. More research is needed to assess the impact of other factors, such as climate, socioeconomics, patient age populations, and community resources on these regional variations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Distribution, Regional medical programs

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A national study of psychiatric hospital care

Article Abstract:

In 1988 a 200-item questionnaire was mailed to administrators of all nonfederal psychiatric hospitals and inpatient care units in the United States to assess recent trends in inpatient services. Responses were received from 173 state and county mental hospitals, 176 private hospitals and 566 psychiatric units in general hospitals. Several emerging patterns were revealed. Public hospitals are now more likely to treat schizophrenic patients than are private hospitals, while private specialty hospitals now treat 50 percent more patients diagnosed with depression than public hospitals. General and nonprofit hospitals are much more likely to offer emergency services than private or specialty hospitals. Recent increases in the number of private psychiatric hospitals have led to more choice concerning type of treatment and environmental settings for patients who can afford their services. In particular, many new services are now provided for young children and adolescents. However, despite large increases in payments to most facilities by Medicare and Medicaid, treatment resources for seriously mentally ill patients who depend on public financing have not improved. There has been a general improvement in patient-to-staff ratios among all types of hospitals. Although this suggests an improvement in the quality of care, it is posited that many staff increases are related to increases in staff psychiatrists and nurses, implicating an increasing trend toward a medical model of psychiatry. This translates to more reliance on drug therapy, particularly in general hospital settings. The merits of this change are now a much debated aspect of mental health policy. Issues being debated center around the complicated interactions between clinical needs of patients, government policies, economic incentives and scientific advances related to psychiatric disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Practice, Psychiatry, Psychiatric hospital patients

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Partial hospitalization: an update

Article Abstract:

The partial hospitalization of patients with serious mental disorders has been successful; therapeutic and economic advantages have been observed. Traditional methods of full outpatient or inpatient treatments are still more frequently used and are also usually preferred by insurance carriers. The original concept of partial hospitalization is over 50 years old and was first instituted because of lack of funds and space. Since then, a number of studies have supported therapeutic advantages to this method. Operational guidelines and standards have been created to meet third-party coverage requirements. In 1980 the Task Force on Partial Hospitalization of APA's (American Psychiatric Association) New York County District Branch devised a definition of partial hospitalization that encompasses major diagnostic, medical, psychiatric, psychosocial, and prevocational treatment models. These are used in conjunction with intensive, comprehensive, and multidisciplinary therapies outside of the outpatient setting. The programs offer an alternative which is both flexible and less restrictive than inpatient programs. More than 1,000 such programs are currently underway which meet the APA criteria. Some specific programs are outlined and staffing and referral supports are also discussed. There are many advantages to this type of program for the psychiatrist, as well as the patient. In spite of this, partial hospitalization programs remain underutilized and are often poorly reimbursed by third-party carriers. The implementation of these programs remains complex and until more psychiatrists are trained in the use of this alternative, this method will probably continue to be underutilized. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Innovations, Partial hospitalization

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