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How do Trends for Behavioral Health Inpatient Care Differ from Medical Inpatient Care in U.S. Community Hospitals?

BACKGROUND: Inpatient care in the United States accounts for one third of the health care expenditures. There exists a well-established trend towards fewer inpatient admissions and shorter lengths of stay for all inpatient care, which can be attributed to cost containment efforts through managed care and advances in treatment technologies. However, different illnesses may not necessarily share the same pattern of change in inpatient care utilization. In particular, mental health and substance abuse (MHSA) care has experienced a particularly dramatic growth of specialized managed behavioral organizations, which could have led to an even faster decline. AIMS OF THE STUDY: This study contrasts the trends of MHSA inpatient care in U.S. community hospitals with medical inpatient care over the years 1988 to 1997. It also analyzes the trends for subgroups of MHSA stays by diagnostic groups, age and primary payer. METHODS: We use the National Inpatient Sample (NIS) from the Health Care Cost and Utilization Project (HCUP) to estimate both number of inpatient discharges per 1,000 population and average length of stay over the years and relate the two indices. Inpatient MHSA stays are categorized into subgroups by age, primary payer of the care, and diagnostic group. We use the Clinical Classification Software (CCS) to distinguish between affective disorders, schizophrenia and related disorders, other psychoses, anxiety and related disorders, pre-adult disorders, and alcohol-, substance- related mental disorders and other mental disorders. Trends of population adjusted discharges and length of stay were tested using a weighted least squares method. RESULTS: Population-adjusted MHSA discharges from community hospitals increased by 8.1% over the study period, whereas discharges for all conditions decreased. Within MHSA discharges, the 20-39 and 40-64 age groups experienced significant increase relative to other age group; the increase was particularly high for affective and psychotic disorders, which are only partially offset by a decrease for other diagnostic groups. Hospitalization for both MHSA and medical conditions displayed trends towards shorter lengths of stay, but with the decline for MHSA stays steeper (40%) than for all stays (21%). The reduction in length of stay not only applied to the privately insured, for which managed behavioral health care had the highest penetration rate, but held for all other payers as well, although the rate of decline is higher for private insurance than for other insurance. Inpatient stays with pre-adult disorders displayed the greatest percentage decline for both population-adjusted discharges and average length of stay. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Different pattern of utilization emerged for MHSA inpatient care as compared to hospitalization for all medical care over the years 1988-97. The more rapid decline in length of stay for MHSA stays than for all stays may have been a result of greater incentive for cost containment and therefore more intensive care management, and advances in treatment technology, especially medication. However, the fast decline in length of stay may also have led to repeat hospitalization as a result of premature discharges for patients with affective or psychotic disorders. Some financial incentives, such as case-rates or DRG-type payments to hospitals could have contributed to such adverse effects. Increases in discharges for severe disorders could also be a consequence of shifts from long-term facilities (for which no comparable data are available) to community hospitals, although the largest absolute and relative increases were for affective disorders rather than schizophrenia or other psychoses, the two disease subgroups that make up the majority of the institutionalized patients. International comparisons, assisted by new data, may help disentangle the effect of institutional change and that of development in treatment technology or practice pattern.

Journal Article↗

Beginning with the application in mind: designing and planning health behavior change interventions to enhance dissemination.

Failing to retain an adequate number of study participants in behavioral intervention trials poses a threat to interpretation of study results and its external validity. This qualitative investigation describes the retention strategies promoted by the recruitment and retention committee of the Behavior Change Consortium, a group of 15 university-based sites funded by the National Institutes of Health to implement studies targeted toward disease prevention through behavior change. During biannual meetings, focus groups were conducted with all sites to determine barriers encountered in retaining study participants and strategies employed to address these barriers. All of the retention strategies reported were combined into 8 thematic retention categories. Those categories perceived to be most effective for retaining study participants were summarized and consistencies noted among site populations across the life course (e.g., older adults, adults, children, and adolescents). Further, possible discrepancies between site populations of varying health statuses are discussed, and an ecological framework is proposed for use in future investigations on retention.

Behavior Therapy↗

[Diet and health behavior in Danish children aged 11-15 years].

A total of 1,671 school children aged 11, 13 and 15 years answered a questionnaire on diet, other health behaviour, social background, social network, health and life satisfaction. The proportions who ate fruit, vegetables, and rye bread every day were 77%, 64% and 94%. Moreover, 78% had fibre-containing breakfast every day and 79% had a regular lunch meal every day. 26% of the children received an optimal diet containing all of these five components every day, and 19% received less than three of these components every day. The proportions who consumed five unhealthy diet components every day (candy, chips, French fries, sausages/hamburgers, and sweet longdrinks) were 32%, 12%, 5%, 5%, and 18%. 39% received at least one of these unhealthy diet components every day. There was no association between intake of healthy and intake of unhealthy diet components. We found no age differences among boys regarding the healthy diet components but an increasing consumption of unhealthy components with increasing age. Among girls we found a decreasing consumption of both healthy and unhealthy components with increasing age. Healthy diet was associated with high social class, good health, positive life satisfaction, positive school assimmilation, and positive health behaviour.

Adolescent↗

Use of preventive health behaviors by lesbian, bisexual, and heterosexual women: questionnaire survey.

OBJECTIVES: To determine whether lesbians and bisexual women are less likely than heterosexual women to use preventive health measures. DESIGN: Written, anonymous, self-administered questionnaire. SETTING: 33 physicians' offices and community clinics mainly in urban areas of 13 states. PARTICIPANTS: 524 lesbians, 143 bisexual women, and 637 heterosexual women. RESULTS: Bisexual women were less likely than heterosexual women to have had appropriate cholesterol screening (odds ratio 0.29, 95% confidence interval 0.11 to 0.73) or appropriate mammography (0.33, 0.13 to 0.84). Human immunodeficiency virus testing was more common in lesbians (2.38, 1. 51 to 3.74) and bisexual women (1.99, 1.17 to 3.38) than in heterosexual women. Illicit drug use was higher in lesbians (2.04, 1. 14 to 3.70) and bisexual women (1.96, 1.07 to 3.57) than in heterosexual women. Lesbians were more likely than heterosexual women to practice safer sex (2.60, 1.23 to 5.49) and less likely to have ever been infected with human papillomavirus (0.48, 0.25 to 0. 89). CONCLUSION: There were important differences in the preventive health measures taken by lesbians and bisexual women and those taken by heterosexual women. All patients should receive standard health tests, such as cholesterol screening and mammography, regardless of their sexual orientation. Lesbians and bisexual women who report illicit drug use should receive counseling, as appropriate.

Adult↗

Venomous marine animals of Florida: morphology, behavior, health hazards.

This article reviews the dangers related to marine animal envenomations in Florida. Venomous marine animals exhibit diverse mechanisms of injury and toxicity. Information regarding the morphology, behavior, and health hazards of these dangerous organisms is presented to help medical personnel recognize, diagnose and treat marine envenomations. Hazardous marine animals discussed in this review include both invertebrates and vertebrates. Stinging invertebrate animals include sponges, coelenterates (jellyfish, hydroids, corals, and sea anemones), echinoderms (sea urchins, starfish and sea cucumbers), annelid worms (bristleworm), and mollusks (cone shells, octopi and nudibranches). Stinging vertebrates discussed include stingrays, catfish, scorpionfish, and leatherjacks.

Animals↗

Preventive oral health behaviors among Detroit-area residents.

PURPOSE: It has been recommended that adults brush and floss their teeth daily and have periodic oral health checkups. A study was conducted to determine if those recommendations are followed. METHODS: Data were collected during face-to-face interviews with a probability sample of 662 dentate adults residing in the Detroit metropolitan area from August to November 1989. Participants were asked how frequently they brushed, flossed, and had checkups. They were also asked about the thoroughness with which they brushed and flossed, and about the advantages and disadvantages of all three behaviors. Descriptive statistics were calculated. RESULTS: The response rate was 72%. While 97% of subjects reported brushing at least once a day and 32% reported flossing at least once a day, 13% indicated they did not brush all teeth or all parts of teeth, and one-third of those who said they flossed daily did not floss all teeth. Seventy-three percent of respondents reported getting dental checkups at least once a year. For brushing, insufficient thoroughness was more commonly a problem than insufficient frequency. CONCLUSIONS: Patient education efforts related to brushing will probably be more effective if they focus on thoroughness rather than frequency. Interventions to increase flossing should probably focus on overcoming skill deficits.

Adolescent↗

Life, survival, and behavioral health in small closed communities: 10 years of studying isolated Antarctic groups.

In the late 1980s the Australian Antarctic Division collaborated with NASA to use the Australian National Antarctic Research Expeditions' (ANARE) stations to pursue research of benefit to both programs. This article outlines the data collection efforts, the development of analyses, and selected results, and describes some of the benefits for the aerospace, health, and environmental psychology communities. The Behavior and Performance Laboratory at Johnson Space Center developed a questionnaire to sample broadly the many aspects of life in extreme environments analogous to space missions. Data were collected from volunteers involved in various ANAREs conducted from 1994 to 2003. Pool-timed series regression, hierarchical models, and content analysis have all enhanced the understanding of the kinds of psychosocial variables relevant in extreme environments, and how these variables relate to each other; examples are given. Observations gathered over the last 10 yr comprise a unique, comprehensive, and advanced representation of psychosocial factors in this extreme environment and provide a strong base for future research and application.

Adaptation, Psychological↗

Relationship of learned resourcefulness to measures of pain description, psychopathology and health behavior in a sample of chronic pain patients.

OBJECTIVE: We investigated the association between the coping style of learned resourcefulness and the variables of pain description, pain locus of control, psychological distress, and health-care utilization. DESIGN: A cross-sectional, retrospective, correlational design was used. PATIENTS AND SETTING: The sample was comprised of 87 outpatients from a university-based, multidisciplinary pain clinic. MAIN OUTCOME MEASURES: Self-Control Schedule, pain intensity, McGill Pain Questionnaire, Pain Locus of Control Scale, SCL-90-R, Health-Care Utilization Questionnaire. RESULTS AND CONCLUSIONS: Results indicated that chronic pain patients obtained comparable resourcefulness ratings to normal subjects but there were wide individual differences. Consistent with theoretical predictions, resourcefulness was found to be associated with better psychological adjustment and less impulsive health-care measures. Results suggest that assessment of learned resourcefulness may be useful in predicting behavioral outcome in clinical settings with chronic pain patients.

Adaptation, Psychological↗

Health-risk behaviors and health promotion in adolescent and young adult cancer survivors.

A diagnosis of cancer during adolescence, a period characterized by experimentation and risk-taking behaviors, has the potential to derail critical developmental tasks required for successful transition into adulthood. Health professionals caring for adolescents and young adults have an opportunity to influence behavioral practices by correcting knowledge deficits, addressing factors that enhance the survivor's sense of vulnerability to health problems, and providing personalized health counseling that encourages the practice of health promoting behaviors. The approach to health counseling in childhood cancer survivors should consider their unique educational needs related to their cancer experience. Previous investigations of adolescent and young adult survivor health behavior indicate that survivors perceive themselves as more vulnerable to health problems than their peers without cancer and recognize a need to protect their health. However, these perceptions of health vulnerability do not always correlate with health promoting behavioral practices, suggesting that factors other than health perceptions should be investigated to motivate behavioral change. Very few studies have been undertaken to prospectively evaluate the effectiveness of health promotion programs in adolescent and young adult survivors of cancer. The scarcity of knowledge in the issue of health promotion after childhood cancer underscores the need for more research to define 1) the optimal timing of health counseling; 2) the influence of developmental status and neurocognitive function; 3) the most effective methods and venues for health education; 4) the feasibility and cost-effectiveness of health promotion strategies; and 5) psychosocial and economic impediments to practice of healthy behaviors.

Adolescent↗

Office system interventions supporting primary care-based health behavior change counseling.

CONTENT: This article reviews the literature on the effectiveness of office system interventions to improve behavior-change counseling in primary care. These instructions consist of two principle components: tools and teamwork. Tools have been developed to assist providers with health risk assessment (questionnaires, health risk appraisals), prompting and reminding (chart stickers, checklists, flow charts, reminder letters), and education (manuals and handbooks). Teamwork entails the coordination and delegation of tasks between providers and staff. CONCLUSIONS: A number of clinical trials, particularly in the area of smoking cessation, have demonstrated the effectiveness of tools and teamwork for increasing counseling rates and counseling effectiveness. Although no one type of tool or method of teamwork is consistently more effective than another-with effectiveness varying according to practice, provider, and patient characteristics-the use of different tools and teamwork approaches leads to additive improvements in counseling and patient behavior-change rates. More high-quality research is needed, particularly in the areas of health risk assessment and electronic reminder systems, to develop effective office interventions that can be readily implemented into a wide variety of primary care practices.

Counseling↗

Bias and heteroscedastic memory error in self-reported health behavior: an investigation using covariance structure analysis.

BACKGROUND: Frequent use of self-reports for investigating recent and past behavior in medical research requires statistical techniques capable of analyzing complex sources of bias associated with this methodology. In particular, although decreasing accuracy of recalling more distant past events is commonplace, the bias due to differential in memory errors resulting from it has rarely been modeled statistically. METHODS: Covariance structure analysis was used to estimate the recall error of self-reported number of sexual partners for past periods of varying duration and its implication for the bias. RESULTS: Results indicated increasing levels of inaccuracy for reports about more distant past. Considerable positive bias was found for a small fraction of respondents who reported ten or more partners in the last year, last two years and last five years. This is consistent with the effect of heteroscedastic random error where the majority of partners had been acquired in the more distant past and therefore were recalled less accurately than the partners acquired more recently to the time of interviewing. CONCLUSIONS: Memory errors of this type depend on the salience of the events recalled and are likely to be present in many areas of health research based on self-reported behavior.

Adult↗