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PubMed2004

Comparison of inpatient and outpatient upper gastrointestinal haemorrhage.

BACKGROUND AND AIMS: Inpatients developing upper gastrointestinal (GI) haemorrhage are at increased risk of death. This study was performed to elucidate differences in inpatients and outpatients. PATIENTS/METHODS: Three hundred and sixty-two patients who needed esophagogastroduodenoscopy for upper GI bleeding were identified from endoscopy charts. Patients' characteristics, bleeding parameters, clinical presentation, pre-existing medication, and laboratory data were compared between patients who were admitted because of upper GI bleeding and patients who developed bleeding while in hospital for other reasons. RESULTS/FINDINGS: Hospital mortality was 39.0% in inpatients vs. 11.1% in outpatients (p<0.01). Death due to bleeding was observed in 9.5% of inpatients vs. 2.5% of outpatients (p<0.01). Whereas peptic ulcer was the most common source of bleeding in both, variceal bleeding was the most common cause of death because of haemorrhage in both. Recurrent bleeding was associated with mortality in outpatients (p<0.001), but not in inpatients (p=0.11). Rates of bleeding recurrence and need for surgery was similar in both groups. Inpatients suffered more often from renal disease, pulmonary disease, diabetes mellitus, coagulopathy, or immunosuppression, and were treated more frequently with acetylsalicylic acid, glucocorticoids and heparin. The frequency of pre-existing disease was higher in inpatients. INTERPRETATION/CONCLUSION: Higher mortality after GI bleeding in inpatients than in outpatients is due to a generally higher prevalence of co-morbidity rather than a single or a few risk factors.

Adult↗

PubMed2006

Rural versus urban inpatient case-mix differences in the US.

BACKGROUND: Preparation of surgeons for practice in rural settings is hindered by limited knowledge of case-mix differences between rural and nonrural surgical practices. Although surgical practice in isolated rural areas is believed to be very different from urban practice, little is known about actual inpatient case-mix differences. STUDY DESIGN: We performed a retrospective, descriptive comparison of inpatient general surgical procedures performed at rural versus urban hospitals in the US using the Nationwide Inpatient Sample database (2000 to 2001). Rural versus urban geographic designations were based on Rural-Urban Commuting Area codes developed by the Rural Health Research Institute. Inpatient surgical procedures were aggregated by the Clinical Classifications Software based on ICD-9-CM procedure codes. RESULTS: Operations on the bowel, appendix, and gallbladder constitute 61% of general surgical inpatient procedures in rural hospitals, compared with 46% in urban hospitals. Compared with urban general surgery practices, rural practices include substantially fewer operations on the stomach and esophagus (6% versus 11%), liver and pancreas (0% versus 1%), spleen and thyroid (3% versus 10%), and bowel (17% versus 19%). General surgical procedures constitute 42% of inpatient procedures in rural hospitals versus 25% in urban hospitals. A rural general surgeon more broadly trained in selected obstetric and gynecologic operations could potentially perform 66% of all inpatient procedures in rural hospitals. Addition of simple vascular cases (eg, arteriovenous fistula, vascular access), head and neck operations, amputations, and nephrectomies could increase this potential to 71% of all cases. CONCLUSIONS: Rural and urban general surgical inpatient case-mixes differ from each other substantially. Additional competence in a few surgical areas that are not currently emphasized in general surgical training could result in an increased role for general surgeons practicing in rural areas.

Diagnosis-Related Groups↗

PubMed2004

Determinants of death in an inpatient hospice for terminally ill cancer patients.

OBJECTIVE: Despite the strong emphasis on home-based end-of-life care in the United States and the recognition of dying at home as a gold standard of quality of care, hospice home care is not a panacea and death at home may not be feasible for every terminally ill cancer patient. Admission to an inpatient hospice and dying there may become a necessary and appropriate solution to distressing patients or exhausted families. However, the factors associated with death in an inpatient hospice have not been examined in previous studies. METHODS: A prospective cohort study was conducted to investigate the determinants of death in an inpatient hospice for terminally ill cancer patients. Approximately two-fifths (40.8%) of the 180 terminally ill cancer patients in this study died in inpatient hospices over the 3-year study period. RESULTS: Results from Cox proportional hazards model with adjustment for covariates revealed several factors that were significantly associated with dying in inpatient hospice, as opposed to home, in a nursing home, or in the hospital. Patients were more likely to die in an inpatient hospice if they received hospice care before death (hazard ratio [HR] = 7.32, 95% confidence interval [CI]: 3.21-16.67), if they had a prestated preference to die in an inpatient hospice (HR = 4.86, 95% CI: 2.24-10.51), if they resided in New Haven County (HR = 1.70, 95% CI: 1.00-2.93), or if they experienced higher levels of functional dependency (HR = 1.05, 95% CI: 1.02-1.08). SIGNIFICANCE OF RESULTS: The high prevalence of inpatient hospice deaths for terminally ill cancer patients in this study was related to the local health care system characteristics, health care needs at the end of life, and personal preference of place of death. Findings from this study may shed light on future directions for developing end-of-life care tailored to the needs of cancer patients who are admitted to hospices and eventually die there.

Attitude to Death↗

PubMed2006

Increasing antibiotic resistance among isolates of Escherichia coli recovered from inpatients and outpatients in a Saudi Arabian hospital.

OBJECTIVE: To study the pattern of antibiotic resistance among Escherichia coli and the trend in resistance during a 6-year period in a Saudi Arabian hospital. DESIGN: Retrospective in vitro surveillance study of the antibiotic susceptibility pattern among E. coli isolates recovered from outpatients and from inpatients. SETTING: A general hospital in Saudi Arabia. PATIENTS: All patients with a culture positive for E. coli during a 6-year study period. RESULTS: A statistically significant increase in antibiotic resistance was observed among outpatient and inpatient isolates of E. coli. Inpatient isolates were more likely to be resistant to antimicrobial agents. Among isolates from outpatients, 50% were resistant to ampicillin, 33% were resistant to trimethoprim-sulfamethoxazole (TMP-SMZ), and 14% were resistant to ciprofloxacin. Among isolates from inpatients, 63% were resistant to ampicillin, 44% were resistant to TMP-SMZ, and 33% were resistant to ciprofloxacin. There was a low rate of resistance to imipenem (0.3% of isolates), amikacin (2%), and nitrofurantoin (2.4%-6.5%). Resistance to ceftazidime was detected in 9% of outpatient isolates and 17% of inpatient isolates. Multidrug resistance was defined as resistance to 2 or more classes of antibiotics. Multidrug resistance was detected in 2.0%-28.1% of outpatient isolates and 7.4%-39.6% of inpatient isolates, depending on the combination of antimicrobials tested. More isolates were resistant to ampicillin plus TMP-SMZ than to any other combination of antimicrobials. CONCLUSION: The prevalence of antibiotic resistance among outpatient and inpatient E. coli isolates increased during the study period. The rates of antibiotic resistance were statistically significantly higher among inpatient isolates, compared with outpatient isolates. These findings call for wiser use of antibiotics and continued surveillance of antibiotic resistance.

Anti-Bacterial Agents↗

PubMed1999

Inpatient reports of suspected child abuse or neglect (SCAN): a question of missed opportunities in the acute care setting.

OBJECTIVE: To determine reasons inpatient reports of suspected child abuse or neglect (SCAN) were not initiated at the time of evaluation in the acute care setting. DESIGN: Retrospective case series. SETTING: Urban children's hospital. PATIENTS: Forty-four children with reports of SCAN filed as hospital inpatients between January 1 and December 31, 1993. INTERVENTIONS: None. RESULTS: Prior to admission, the 44 patients were evaluated in the following settings: pediatric emergency department (PED) (50%), general emergency department (GED) (30%), PED and GED (9%), and outpatient clinic (11%). Inpatient reports were more often for suspicion of neglect than for physical abuse, when compared to reports made in the ambulatory setting (P<0.001). In 23% of cases, the injury or illness necessitating admission was not related to the SCAN. Mean delay in filing a SCAN report following admission was 2.7 days (range 0-20 days). In 45% of cases, it was determined that inadequate information was available at the time of the acute visit to file a SCAN report. Compared with admissions from a PED, a higher percent of admissions from a GED had inpatient reports without additional findings after the acute care evaluation (P<0.05). Seventy-five percent of patients in whom no additional information was obtained during the admission required admission to an intensive care unit (ICU) setting. Forty-eight percent (21 of 44) of inpatient SCAN reports were determined substantiated following Child Protective Services (CPS) investigation. Forty-two percent (10 of 24) of those cases in which no additional information was uncovered following admission were determined substantiated. CONCLUSIONS: Inpatient reports are often the result of additional findings obtained after admission. A higher percentage of admissions from a GED than from a PED had inpatient reports of SCAN without additional findings. Patients who have an inpatient report filed for SCAN are often of high medical acuity, less likely to have physical findings, and may present with injuries or illnesses unrelated to the SCAN.

Adolescent↗

PubMed2001

Secondary prevention in patients several years after myocardial infarction: comparison of an outpatient and an inpatient rehabilitation programme.

OBJECTIVE: To compare the effectiveness of secondary preventive measures in patients after myocardial infarction participating in an outpatient rehabilitation programme at a university hospital with those of an inpatient programme in community hospitals. DESIGN: Cross-sectional study of patients several years after myocardial infarction. METHODS: Seven hundred patients who survived myocardial infarction in the period from 1 January 1989 to 31 December 1995 were chosen from archives of the university hospital (350 patients) and from archives of two community hospitals (350 patients). The patients from the university hospital attended an outpatient rehabilitation programme, while the patients from the community hospitals attended an inpatient rehabilitation programme. The data were obtained by questionnaire, clinical examination and laboratory blood analyses. RESULTS: One hundred and eighty patients attending an outpatient and 140 patients attending an inpatient rehabilitation programme responded to the invitation. Among those who were smokers at the time of myocardial infarction, 91% of patients from the outpatient programme versus 77% of patients from the inpatient programme (P < 0.05) gave up smoking and were still non-smokers; 69% versus 48% (P < 0.05) had a lipid-modified diet; 21% versus 36% (P < 0.05) were obese (BMI > 30 kg/m2). Blood pressure > 140/90 mmHg was found in 21% versus 58% (P < 0.05); total cholesterol > 5.0 mmol/l in 67% versus 87% (P < 0.05); and fasting glucose > 5.6 mmol/l in 43% versus 63% (P < 0.05) of patients from the outpatient and the inpatient programmes, respectively. Among prophylactic drug treatments higher usage of beta-blocking agents (56% versus 36%; P < 0.05) and lipolytic agents (43% versus 23%; P < 0.05) and no significant difference in usage of antiplatelet drugs (83% versus 75%) and angiotensin-converting enzyme inhibitors (30% versus 32%) was found in patients from the outpatient programme compared to patients from the inpatient programme. Only regular physical activity was performed better by patients from the inpatient programme than by patients from the outpatient programme (68% versus 50%; P < 0.05). CONCLUSIONS: The outpatient rehabilitation programme of the university hospital resulted in better application of secondary prevention than the inpatient rehabilitation programme of community hospitals.

Aged↗

PubMed2006

Utilisation of inpatient psychiatric services by people with illicit substance abuse in Switzerland.

QUESTIONS UNDER STUDY: The study aims to examine the utilisation of inpatient psychiatric services by people with substance use disorders (SUD), and to identify factors that predict inpatient service use. METHODS: Out of a sample of consecutively referred first-admitted patients from a catchment area in Switzerland, a cohort of 563 individuals with behavioural and mental disorders due to (illicit) substance use was followed over a period of 5 years by means of register data. RESULTS: Every fourth individual of the first-admission sample was admitted for a SUD. Over the 5-year period, average number of inpatient episodes (1.7) was comparable to that of patients with other diagnoses; time in hospital, however, was by far shorter (cumulative: 21 days). 61.6% of the individuals with SUD were treated as inpatients only once; 41.4% were not regularly discharged. Clinical patient characteristics (psychiatric co-morbidity, admission state, clinical improvement during first inpatient stay) and treatment measures (psychotherapy during first inpatient stay, planned aftercare) were the most important predictors of inpatient psychiatric service use over the 5-year period. Associations with sociodemographic background factors were only weak. CONCLUSIONS: These findings suggest that a high number of patients with SUD are contacting inpatient services, but retention in treatment so far is not sufficient for an adequate drug treatment. Efforts need to be intensified to advance the diagnostic process and to improve current treatment strategies in order to achieve better clinical outcomes.

Adolescent↗

PubMed2007

Trends in the inpatient mental health treatment of children and adolescents in US community hospitals between 1990 and 2000.

CONTEXT: Previous work has demonstrated marked changes in inpatient mental health service use by children and adolescents in the 1980s and early 1990s, but more recent, comprehensive, nationally representative data have not been reported. OBJECTIVE: To describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000. DESIGN AND SETTING: Analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationally representative sample of discharges from US community hospitals sponsored by the Agency for Healthcare Research and Quality. PATIENTS: Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder. MAIN OUTCOME MEASURES: Changes in the number and population-based rate of discharges, total inpatient days and average length of stay, charges, diagnoses, dispositions, and patient demographic and hospital characteristics. RESULTS: Although the total number of discharges, population-based discharge rate, and daily charges did not significantly change between 1990 and 2000, the total number of inpatient days and mean charges per visit each fell by approximately one half. Median length of stay declined 63% over the decade from 12.2 days to 4.5 days. Declines in median and mean lengths of stay were observed for most diagnostic categories and remained significant after controlling for changes in background patient and hospital characteristics. Discharge rates for psychotic and mood disorders as well as intentional self-injuries increased while rates for adjustment disorders fell. Discharges to short-term, nursing, and other inpatient facilities declined. CONCLUSIONS: The period between 1990 and 2000 was characterized by a transformation in the length of inpatient mental health treatment for young people. Community hospitals evaluated, treated, and discharged mentally ill children and adolescents far more quickly than 10 years earlier despite higher apparent rates of serious illness and self-harm and fewer transfers to intermediate and inpatient care.

Adolescent↗

PubMedDate not supplied

A cost-minimization analysis of intracervical prostaglandin E2 for cervical ripening in an outpatient versus inpatient setting.

This investigation was undertaken to compare the cost impact of prostaglandin E2 gel delivered intracervically in an outpatient versus an inpatient setting. Eligible pregnant women with a singleton gestation that was beyond 37 weeks gestational age and who had an unfavorable cervix (Bishop score < or = 4) received a single dose of 0.5 mg of prostaglandin E2 intracervically as an outpatient or one or more doses as an inpatient the day before a scheduled induction of labor. After gel placement, the outpatient group was monitored for 2 hours with electronic fetal monitoring before being sent home, while the inpatient group was monitored for 2 hours in a labor and delivery unit and then sent to the maternity unit overnight. The outpatient (n = 40) and inpatient (n = 36) groups were not different in terms of maternal age, race, parity, gestational age, maternal weight, predose Bishop score, or indication for delivery. Patients in the outpatient group incurred significantly less costs ($3835.00 +/- 2172.00 vs $5049.00 +/- 2060.00) and time (74.4 +/- 33.1 hours vs 100.3 +/- 41.6 hours) in the hospital than did patients in the inpatient group. Multiparous patients in the outpatient group, compared with those in the inpatient group, spent fewer total hours in the hospital (56.6 +/- 19.3 vs 90.3 +/- 41.0 hours) and had a lower hospital cost ($2891.00 +/- 1236.00 vs $4704.00 +/- 2100.00). The only difference between the nulliparous groups favored outpatient therapy because of less intrapartum expenses ($730.00 +/- 405.00 vs $1036.00 +/- 487.00). There were no differences between the inpatient and outpatient groups for the frequencies of failed inductions, abnormal fetal heart rate patterns, and cesarean sections. No adverse maternal or neonatal effects with therapy were encountered in either setting. Substantial cost savings were found with prostaglandin E2 therapy in an outpatient rather than an inpatient setting for patients who required an induction of labor and were candidates for outpatient cervical ripening.

Administration, Intravaginal↗

PubMed2002

A controlled trial of inpatient and outpatient geriatric evaluation and management.

BACKGROUND: Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional status remain uncertain. METHODS: We conducted a randomized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers. After their condition had been stabilized, patients were randomly assigned, according to a two-by-two factorial design, to receive either care in an inpatient geriatric unit or usual inpatient care, followed by either care at an outpatient geriatric clinic or usual outpatient care. The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs standards and published guidelines. The primary outcomes were survival and health-related quality of life, measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), one year after randomization. Secondary outcomes were the ability to perform activities of daily living, physical performance, utilization of health services, and costs. RESULTS: A total of 1388 patients were enrolled and followed. Neither the inpatient nor the outpatient intervention had a significant effect on mortality (21 percent at one year overall), nor were there any synergistic effects between the two interventions. At discharge, patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales, activities of daily living, and physical performance than did those assigned to usual inpatient care. At one year, patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale, even after adjustment for the score at discharge, than those assigned to usual outpatient care. Total costs at one year were similar for the intervention and usual-care groups. CONCLUSIONS: In this controlled trial, care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival. There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management, with no increase in costs.

Activities of Daily Living↗

PubMedDate not supplied

Temporal trends and associated factors of inpatient cardiac rehabilitation in patients with acute myocardial infarction: a community-wide perspective.

PURPOSE: Cardiac rehabilitation (CR) has been shown to be an important therapeutic intervention after the development of acute myocardial infarction (AMI), but historically has been underused. Inpatient CR often represents cardiac patients' first exposure to risk factor modification education and acts as a gateway to outpatient programs. METHODS: The authors performed a longitudinal study of the use of inpatient CR in 5204 Worcester residents hospitalized with validated AMI in seven 1-year periods between 1986 and 1997. RESULTS: The overall rate of referral to inpatient CR was 68%, with a slight decline in use to less than 60% in the authors' most recent study year of 1997. Referred patients were significantly more likely to be younger, male, or enrolled in a health maintenance organization; they were less likely to have a history of heart failure or stroke. They were significantly more likely to receive medications shown to be of benefit in the management of AMI and to undergo cardiac interventional procedures. In 1997, patients participating in inpatient CR were more likely to have documented inpatient counseling about nutrition, exercise, smoking, and stress reduction. DISCUSSION: The results of this multihospital community-wide study suggest relatively stable, but recently decreasing, use of inpatient CR over the past decade. Women and the elderly are underrepresented in these programs. Patients not referred to inpatient rehabilitation were less likely to be prescribed effective cardiac medications and undergo risk factor modification counseling prior to discharge. Further studies are needed to better understand the reasons for patient exclusion from the benefits of inpatient CR.

Aged↗

PubMed2003

A paradigm for treatment of inpatient psychiatric disorders: from asylum to intensive care.

OBJECTIVE: No articles, chapters, or texts have been published in the last 5 years that detail a workable model of inpatient psychiatric treatment based on current, drastically changed realities. METHODS: We reviewed controlled studies on inpatient psychiatric care and pooled our clinical experience from two academic inpatient units and a Veterans Affairs inpatient unit. RESULTS: Major changes in systems of care, the population now being hospitalized, the emphasis on practicing evidence-based medicine, and decreased funding of inpatient psychiatric units have necessitated changes in the traditional paradigm of inpatient treatment. We describe the functions that an inpatient unit performs best and detail 1) objectives of treatment with an emphasis on the "focal problem", and 2) the specific treatment interventions, treatment team members, and outpatient links necessary to maximize post-hospital outcome for patient and family. CONCLUSION: Given current realities, the treatment paradigm that we recommend has evolved from an asylum-like long-stay model to one that is more like a medical-surgical intensive care unit with an emphasis on rapid diagnosis, psychopharmacological intervention, and laying the groundwork for effective outpatient management. In consequence, the expected clinical outcomes from an episode of inpatient psychiatric treatment are quite different from those of the recent past.

Journal Article↗

PubMed1997

Relationship between inpatient alcoholism treatment and longitudinal changes in health care utilization.

OBJECTIVE: The purpose of the study was to evaluate changes in health care utilization associated with inpatient alcoholism treatment in alcoholics of low socioeconomic status with different histories of treatment relapse. METHOD: The sample consisted of more than 85,000 male alcoholics using inpatient care in Department of Veterans Affairs medical centers in fiscal year 1987. Five treatment groups were identified to represent a continuum of length and intensity of alcoholism treatment, including formal inpatient alcoholism treatment, short detoxification and hospitalizations for primary diagnoses other than alcoholism. All inpatient and outpatient health services for 3 years before and 3 years after the index hospitalization were examined for differential changes in utilization associated with the five treatment groups after controlling for patient predisposing, enabling and need characteristics. RESULTS: Both total inpatient days and outpatient visits increased significantly for all treatment groups, with the greatest increases occurring in the group completing inpatient alcoholism treatment (both p < .0001). However, use of inpatient medical care decreased and substance abuse inpatient care increased significantly for most groups, with the largest increases in substance abuse care found for the completed treatment group. CONCLUSIONS: In a hospital system that does not deny care on the basis of ability to pay, certain groups of chronic alcoholics who cannot sustain prolonged remission will continue to be heavy utilizers of services. Alcoholism treatment may be associated with higher short-term costs but it remains to be seen whether provision of more focused treatment services is able to achieve longer term better outcomes and, ultimately, lower costs.

Adult↗

PubMed1998

Relationship between preventive health services and use of inpatient and outpatient care by residents aged 40 or older in 44 municipalities in Osaka Prefecture, Japan.

We examined the relationships between preventive health services provided under the Law for Health and Medical Services for the Elderly and the use of inpatient and outpatient care by insured residents aged 40 or older covered by the National Health Insurance in 44 municipalities in Osaka Prefecture. Factor analyses showed that hospital admission rate and inpatient days per 100 insured persons, bed days per insured person, inpatient days per case, mean bed days, the proportion of long-stay (180 days or more), and the rate of long-stay per 1,000 insured persons accounted for the first factors of inpatient care with factor loadings of more than 0.82. Outpatient utilization rate and outpatient days per 100 insured persons comprised the first factors of outpatient care with factor loadings of more than 0.80. Patient cost per case and the proportion of high patient cost (600,000 Yen or more for inpatient care and 60,000 Yen or more for outpatient care) made up the second factors of either type of patient care with factor loadings of more than 0.87. The frequency of use of health check-ups and the numbers of instruction classes and participants in health education and health counseling per 100 residents showed negative correlations with indices of inpatient and outpatient care, except for patient cost per day. The scores for the first and second factors of inpatient care and for the first factor of outpatient care correlated negatively with all indices of the use of preventive health services. More active provision of preventive health services may therefore contribute to reducing the subsequent use of inpatient and outpatient care among residents aged 40 or older.

Adult↗

PubMed1996

The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects.

Previous reviews have concluded that there was no evidence for the superiority of inpatient over outpatient treatment of alcohol abuse, although particular types of patients might be more effectively treated in inpatient settings. In this review, we first consider the conceptual rationales that have been offered to support inpatient and outpatient treatment. Following that, the results of the relevant research on setting effects are presented. Five studies had significant setting effects favoring inpatient treatment, two studies found day hospital to be significantly more effective than inpatient treatment, and seven studies yielded no significant differences on drinking-related outcome variables. In all but one instance in which a significant effect emerged, patients in the 'superior' setting received more intensive treatment and patients were not 'preselected' for their willingness to accept random assignment to treatment in either setting. Studies finding significant setting effects also conducted more treatment contrasts (18.6 vs. 4.9), on average, and had a mean statistical power level of 0.71 (median 0.79) to detect a medium-sized effect, whereas studies with no significant findings had an average power level of 0.55 (median 0.57). When inpatient treatment was found to be more effective, outpatients did not receive a respite in the form of inpatient detoxification and the studies were slightly less likely to have social stability inclusion criteria and to use random assignment to treatment settings. We consider the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents of inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.

Alcoholism↗

PubMed1997

[Misuse of inpatient care--background, indicators and evaluation parameters].

17a of the German hospital financing law constitutes the basis for the evaluation of not justified hospital admission. It demands not to admit patients into hospital who do not need inpatient treatment or, treat them in an inpatient-setting longer than medical required. Unjustified inpatient treatment results from faulty decision with regard to admission, to adequate intensity of medical care or duration of stay. The priority of outpatient treatment over the pre-, post-, partial and complete inpatient treatment must be taken into consideration at each decision. The following items can indicate unjustified inpatient treatment already prior to the detailed examination of a hospital; length of stay higher than average, a lot of patients staying only a short time, high rate of self-admission, long preoperative period, inadequate relations between age and diagnosis groups, increasing frequency of unspecified symptoms and syndromes in the main treatment diagnosis, peculiarities concerning the categorisation of nursing care etc. The systematic approach to the analysis of unjustified hospital admission requires the evaluation of clinical pictures with the question as to the primary necessity of inpatient treatment, the adequate length of stay and whether there are alternatives of medical care as an outpatient. Testing parameters are, among others, occasion of admission, severity of illness, indication for complete in-patient treatment, utilisation of alternatives to medical care (outpatient, pre-, post-, partial inpatient treatment), adequacy of diagnostic or therapeutic intervention with regard to the disease, intensity, respectively chronological sequence of medical procedures, efficiency of organizational processes, transfer or discharge in time. The evaluation of unjustified admission to inpatient treatment should be conducted with a systematic approach including standardised methods and an adequate sample size on the basis of the individual medical report. In 1995 an outline as to testing of unjustified hospital admission as already presented by Bundes-Arbeltsgemeinschaft der Medizinischen Dienste der Krankenversicherung.

Cost Control↗

PubMed1997

Psychogeriatric inpatient suicides in Australia.

Psychiatric inpatients have a higher suicide rate than the general population. Psychogeriatric inpatients suicides over a 21-year period, in a large psychiatric hospital in Melbourne were examined. Only 8% of all inpatient suicides were by those aged over 60 years. Psychogeriatric inpatients suicides, when compared to younger inpatient suicides, were more likely to have depression, less likely to have schizophrenia, have more children and have a longer interval between the age of onset of the illness and the index admission. These associations were probably a function of age. Psychogeriatric inpatient suicides, when compared with psychogeriatric 'alive' inpatients, were associated with depression, alcohol misuse and preadmission and intra-admission suicidal ideation. A high index of suspicion and vigilance among staff for elderly patients with these features is suggested.

Age Distribution↗

PubMed2004

Transfers to civil psychiatric inpatient services from a maximum security forensic hospital.

OBJECTIVE: To examine inpatients discharged from a forensic psychiatric hospital to a civil hospital at the completion of their correctional sentence. METHOD: Extract information from a patient database. RESULTS: About 20% of the discharges from the New York State forensic hospital that serves mentally ill state prison inmates, Central New York Psychiatric Center (CNYPC), are transferred to a civil psychiatric hospital; the remainder are returned to a correctional setting. Although their diagnoses, Global Assessment of Functioning scores, and number of prior inpatient admissions are similar, CNYPC transfers stay 1(1/2) times as long in their civil hospital admission as other civil hospital admissions. If total inpatient hospitalization before release to the community at large is considered (CNYPC plus the subsequent civil hospital), the stay is about 2(1/2) times as long. Fifty-two percent of the CNYPC transfers had been incarcerated for violent offenses and 28% are re-hospitalized within 12 months after release from the civil hospital. DISCUSSION: Longer lengths of stay in the civil hospital for these CNYPC transfers do not seem to be related to psychiatric functioning. Instead, it may be related to being harder to place in a community setting. All these CNYPC transfers have prison histories, many have a violent offense history, and all have been geographically remote from their home communities for a long time periods. As a result, the social support networks of CNYPC transfers may be weaker than those of other civil inpatients. The families and neighborhood agencies of CNYPC transfers are probably less willing to accept them on their return than those of other civil patients.Enhanced discharge planning and support services targeted specially for correctional transfers to a civil psychiatric inpatient environment should be considered. These type of service may reduce inpatient length of stay and thereby allow the inpatient resources to be used by other patients.

Forensic Psychiatry↗