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Biomedical subjects

W H Fisher

Publications and source records attributed to W H Fisher.

16 recordsLinked to original sources
PubMed1992

Adult lifetime prevalence of firesetting behaviors in a state hospital population.

Hospital records of all patients under age 65 years old on the census of Worcester State Hospital (WSH) on October 25, 1988 (n = 279) were reviewed for indications of firesetting behaviors during the individuals' adult lifetime. The prevalence of firesetting behaviors was found to be 27.2%. The prevalence of firesetting episodes, a subset of firesetting behaviors, was found to be 17.6%. A stepwise discriminant function analysis was used to determine whether any factors significantly differentiated the members of the firesetting behavior group from the remainder of the population. This analysis revealed that the number of WSH admissions, the number of admissions to other inpatient facilities, and a history of injurious behavior to self are significant positive predictors of membership in the firesetting behaviors group. The results of the WSH analysis are very similar to those found at Northampton State Hospital in 1983. These high prevalence rates have implication for treatment, education, record keeping, and liability.

Adult↗
PubMed1992

Who repeats? A follow-up study of state hospital patients' firesetting behavior.

The authors report on a population of psychiatric patients who were studied over a 6.75 year period to determine the occurrences of firesetting behavior noted in their psychiatric inpatient records. Two groups of 50 patients each were drawn from an earlier study and were matched by sex, age, and diagnoses. One group of patients had prior firesetting behavior; the other did not. Firesetting behavior was found not only in patients originally identified as having previously engaged in this behavior, but also in those with no documented history of this act prior to the period of the study. Patients having firesetting behavior in their past psychiatric record set more actual fires. Total number of episodes of firesetting behavior, however, was not significantly different between the two groups. Results are discussed in terms of the communicative function of firesetting and the dilemma of clinical prediction.

Female↗
PubMed1992

The relationship between community resources and state hospital recidivism.

OBJECTIVE: The authors examined the propositions that a revolving state hospital door is an inevitable consequence of deinstitutionalization and that enhancing resources for community-based care can limit this phenomenon. METHOD: They analyzed the recidivism patterns of state hospital patients in a region of Massachusetts where, because of a federal court consent decree, the level of funding for community programs was more than twice as high as it was in other regions in the state and compared the pattern of recidivism in this region with that observed in the other areas of the state. RESULTS: Despite the fact that the average daily state hospital census in the resource-rich region was only half that of the other regions, longitudinal data on hospital use showed that the readmission patterns were similar in all state regions. CONCLUSIONS: The authors suggest that attributes of serious and persistent mental illness may have more effect on hospital readmission patterns than service system variables.

Community Mental Health Services↗
PubMed1992

The role of general hospitals in the privatization of inpatient treatment for serious mental illness.

For almost three decades, many have regarded general hospital psychiatric units as the most appropriate setting for acute treatment of persons with serious mental illness who were once treated mostly in state hospitals. The extent to which this transfer has taken place and the differences between public and private general hospitals have been unclear. Using data from the 1988 National Mental Health Facilities Study and published data from the 1970s, the authors found that nearly half of all general hospitals providing psychiatric services treat persons with serious mental illness. Significant differences in case and payer mix were observed between public and private general hospitals, although these differences were smaller than in the 1970s. The findings suggest increased involvement by private general hospitals in treating patients reimbursed by public payers, but the findings also indicate that persons with serious mental illness and those using Medicaid are still more prevalent in public general hospitals than in private ones.

Community Mental Health Services↗
PubMed1992

Are pretrial commitments for forensic evaluation used to control nuisance behavior?

The shift to dangerousness-oriented civil commitment criteria has led to speculation that mentally ill persons who do not meet those criteria are being hospitalized under criminal commitment statutes. Using data on patients' psychiatric symptoms at admission to a state hospital in Massachusetts, the authors retrospectively assessed whether patients charged with minor criminal offenses who were committed for evaluation of competence to stand trial would have met civil commitment criteria. The data suggest that most mentally ill patients who were criminally committed could have been civilly committed. However, a relatively greater proportion of persons with substance abuse, mental retardation, or other conditions who did not meet civil commitment criteria for mental illness were committed for pretrial evaluation.

Adult↗
PubMed1991

Contracting between public agencies and private psychiatric inpatient facilities.

Purchasing human services through contracts with private providers has become an increasingly common practice over the past 20 years. Using data from a national survey of psychiatric inpatient facilities, this paper examines the extent to which psychiatric units in privately controlled general hospitals and private psychiatric specialty hospitals (N = 611) participate in contractual arrangements to provide services to governmental bodies. It also examines how the likelihood of such a practice is affected by hospital characteristics (general or specialty, for profit or nonprofit) and features of hospitals' environments, including the competitiveness of the market for psychiatric inpatient care and the population's need for services in the hospital's county. The findings indicate that nonprofit psychiatric specialty hospitals were more likely than other types of hospitals to enter into such contracts, and that forces such as local competition and need for services were not predictors of such involvement. Contracting was shown to have a significant impact on the level of referrals a hospital accepted, but these levels were also affected by competition and need. Among hospitals with public contracts, referral acceptance from public agencies was unaffected by these factors, but they did have a significant effect on referral acceptance by hospitals without public contracts. These data suggest that public agencies contracting for services with private hospitals may represent a means by which "public sector" patients may gain access to private providers. Further, this mechanism may impose sufficient structure and regulation on the acceptance of such patients that many concerns of hospital administrators regarding patients who are costly and difficult to treat and discharge can be allayed.

Contract Services↗
PubMed1991

Geriatric patients and services in state hospitals: data from a national survey.

Notwithstanding the large-scale deinstitutionalization of the elderly, psychogeriatric patients continue to make up a significant portion of patients in U.S. state hospitals. This paper reports pilot data from a national survey assessing the current status of geriatric populations in state hospitals. Elderly patients still account for one-fifth of state hospital patients, and two-thirds of state hospitals still have separate geriatric units. The data suggest that, while deinstitutionalization of the elderly may be continuing in many state hospitals, in more than one-third of state hospitals the geriatric census is on the rise. Tentative hypotheses suggesting further research are discussed.

Aged↗
PubMed1991

Effect of evaluations of competency to stand trial on the state hospital in an era of increased community services.

The authors studied court-ordered inpatient evaluations of competency to stand trial at two Massachusetts state hospitals for the period from 1972 to 1987, with particular attention to the effects of a 1978 federal court consent decree that created an extensive system of community-based services in the catchment area of one of the hospitals. The authors found that the broad array of community services developed under the consent decree did not reduce commitments to the state hospital for evaluation of competency to stand trial at the same rate as it reduced civil commitments, with the result that the composition of the patient population changed to include a significantly larger proportion of patients referred by the criminal justice system. This proportion was as high as 17.8 percent in 1985. These patients used a disproportionate share of the hospital's resources, staying in the hospital for a median of 28 days, compared with 12 days for all other patients.

Antisocial Personality Disorder↗
PubMed1990

Empirically assessing the impact of mobile crisis capacity on state hospital admissions.

The literature on emergency psychiatric services contains numerous claims to the effect that mobile crisis capacity reduced hospitalization by resolving emergencies in the community. To date these claims have not been substantiated by empirical analysis. This study, using 1986 data from Massachusetts, compares first and total admission rates of catchment areas with mobile capacity to those without such services, controlling for differences in community resources and demand for hospitalization. This analysis showed no effect of mobile capacity on admission rates. These findings are not interpreted as evidence of the ineffectiveness of mobile services, but are seen as indicative of the need for further empirical investigation of these services.

Analysis of Variance↗
PubMed1990

Modeling the growth of long-stay populations in public mental hospitals.

Long-stay, chronic patients have been a problematic subpopulation in public mental hospitals for over a century. Despite three decades of deinstitutionalization and a major shift toward shorter episodes of hospitalization, there continues to exist a group of patients who experience lengthy hospital stays. As the number of such patients increases in a facility, its ability to provide acute care may be compromised, and the size of this subpopulation must therefore be anticipated. This paper examines the length-of-stay patterns of a sample of public mental hospital admissions through the use of life table analysis, and develops a dynamic modeling algorithm using sample survival function values. Life table analysis revealed a declining hazard function, indicating a diminishing probability of discharge with increased hospital stay. The dynamic model showed that, after 2 years of operation of a hypothetical facility, current length-of-stay patterns would generate an inpatient population 40% of which had been hospitalized for over 6 months. Goodness-of-fit tests comparing the algorithm's forecast with actual hospital utilization data showed its predictions to be reliable. The authors discuss the use of this methodology to anticipate the effects of programmatic or other types of changes in mental hospitals, and also suggest other types of settings where such modeling techniques might profitably be applied.

Algorithms↗
PubMed1990

Alzheimer's disease and related disorders in state mental hospitals: data from a nationwide survey.

Notwithstanding three decades of transferring of the elderly to nursing homes, geriatric patients continue to reside in state mental hospitals. Many of these patients, perhaps one-third or more, are thought to suffer from Alzheimer's disease and related disorders (ADRD). This study reports data from a nationwide survey of state hospitals that provides an exploratory look at the ADRD patients currently served in state hospitals. Admission trends, reasons for admission, and sources of referral are described. Civil commitment of nursing home patients with dementing illnesses and the place of the state hospital in the continuum of care for ADRD patients are discussed.

Aged↗
PubMed1990

Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix.

A 1978 consent decree affecting one region of Massachusetts mandated a drastic reduction of census at its state hospital, where considerable deinstitutionalization had already occurred over the prior two decades. The transfer of patients from hospital to community was to be accomplished through the unprecedented expansion of community resources. This second-generation deinstitutionalization effort achieved substantial census reduction but less than was envisioned. It was most effective in discharging geriatric and mentally retarded patients but far less effective with longterm and new chronic patients, many of whom continue to require repeated hospitalizations despite the availability of a comprehensive array of community-based services.

Adolescent↗
PubMed1990

Second-generation deinstitutionalization, II: The impact of Brewster v. Dukakis on correlates of community and hospital utilization.

On the basis of the principle that patients have the right to be treated in the least restrictive setting appropriate to their needs, all 368 patients at Northampton State Hospital (Massachusetts) were discharged over a 10-year period. Three-quarters were discharged to community settings. Half of the patients were never rehospitalized, but many others continued to display patterns of recidivism. On the assumption that socially dysfunctional behavior would improve after discharge, the funded community system emphasized assessments, residential placements, and crisis intervention and deemphasized treatment. The findings raise many questions about the efficacy and wisdom of attempting to serve an entire state hospital population in the community.

Adult↗
PubMed1989

Evaluation and clinical significance of appendicular skeletal assessment by radiographic photodensitometry.

"Senile" or age-related bone loss affects cortical and trabecular bone and may be detected in the appendicular as well as the axial skeleton. This study presents radiographic photodensitometry as a precise and sensitive technique for evaluating appendicular skeletal status. Data from reproducibility studies indicate that the coefficient of variation for the technology is between 1.9% and 4.5% for the three bones analyzed. Evaluation of age-related changes in bone mass for over 800 subjects demonstrated a decline in mass vs. age after the fourth decade in women, with the slope of the decline being very similar to that seen in CT longitudinal studies. Applied serially to a patient over time, the technology identifies changes in bone mass and may be used to evaluate the response to intervention therapy.

Absorptiometry, Photon↗