Factors influencing length of hospital stay.
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Biomedical subjects
Publications and source records attributed to G A Coffman.
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We comparatively examined the relevance of the various components of an expanded DSM-III diagnostic formulation to admission decisions by studying all 745 new patients who came to a 24-hour walk-in clinic during a six-month period and who were admitted to either inpatient or outpatient care at a comprehensive psychiatric institute. A diagnosis of psychotic disorders was found to be significantly associated with hospitalization, while anxiety disorders, adjustment disorders, personality disorders, and nonmental disorder conditions were associated with outpatient referral. The strongest correlations with hospitalization, however, were obtained for current adaptive functioning and, to a lesser extent, for highest level of adaptive functioning in the past year.
On the basis of semistructured evaluations of all new patients presenting for care during a 1-year period at a comprehensive psychiatric facility, the authors systematically assessed the relationship between various aspects of the patients' symptoms and hospitalization decisions. The individual symptoms correlating the highest with hospitalization were self-neglect, disorganized thought process, and impulsivity. Even greater correlations, in increasing order, were obtained for the total number of symptoms present, for delusional psychosis (one of the broad factors underlying the patient's symptoms), and for a linear combination composed of self-neglect, impulsivity, suspiciousness, and suicidal indicators.
The authors present a format that organizes DMS-III diagnoses according to its five axes. For each axis, it provides an ordered listing of several diagnostic categories, their qualification as principal or provisional diagnoses, and alternative categories to be ruled out. For each dimensional axis, the terms and codes of the scale are specified and arranged linearly. This format was used with 1,111 new patients who consecutively applied for care at a comprehensive psychiatric facility during a 6-month period. The authors report on the frequency of use of specific diagnostic categories and dimensional levels along provisional, and rule-out diagnoses were noted.
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