Psychiatric symptom severity and length of stay on an intensive rehabilitation unit

Using geographic variation in unplanned ambulatory care sensitive condition admission rates to identify commissioning priorities: an analysis of routine data from England

Objectives To use geographic variation in unplanned ambulatory care sensitive condition admission rates to identify the clinical areas and patient subgroups where there is greatest potential to prevent admissions and improve the quality and efficiency of care. Methods We used English Hospital Episode Statistics data from 2011/2012 to describe the characteristics of patients admitted for ambulatory care sensitive condition care and estimated geographic variation in unplanned admission rates. We contrasted geographic variation across admissions with different lengths of stay which we used as a proxy for clinical severity. We estimated the number of bed days that could be saved under several scenarios. Results There were 1.8 million ambulatory care sensitive condition admissions during 2011/2012. Substantial geographic variation in ambulatory care sensitive condition admission rates was commonplace but mental health care and short-stay (<2 days) admissions were particularly variable. Reducing rates in the highest use areas could lead to savings of between 0.4 and 2.8 million bed days annually. Conclusions Widespread geographic variations in admission rates for conditions where admission is potentially avoidable should concern commissioners and could be symptomatic of inefficient care. Further work to explore the causes of these differences is required and should focus on mental health and short-stay admissions.

Psychiatric illness and length of stay in general hospitals: do case finding methods matter?

OBJECTIVE

Several prior studies have investigated whether patients with "non-cognitive" mental disorders (i.e., organic disorders, substance abuse, delirium, and psychotic disorders excluded) have longer Length Of Stay (LOS) than mentally healthy individuals in nonpsychiatric hospital settings. These studies yielded contrasting results. The present paper aims to examine whether methods of psychiatric case finding can explain these differences.

METHODS

Using the Clinical Interview Schedule (CIS) and the General Health Questionnaire (GHQ), 462 in-patients of medical, surgical, gynecological, and rehabilitation departments were assessed for the presence of psychiatric disorders.

RESULTS

In multiple regression analysis, all CIS-cases together did not show an association with LOS. Of the diagnostic groups assessed by CIS only major depression showed a significantly prolonged LOS. Using the GHQ sum-score as a continuous variable, LOS was significantly increased while using the GHQ as a dichotomous variable did not show such an association. After removing those suffering from multiple psychiatric diagnoses (such as major depression co-morbid with organic mental illness), none of the case definitions showed a significant association with LOS.

CONCLUSIONS

It seems that different case finding methods yield different results concerning the association of psychiatric disorders with LOS. When interpreting these results the small size of some subsamples must be taken into consideration.

Prevalence and influence of psychiatric comorbidity on rehabilitation outcome for older hospital inpatients

BACKGROUND

The objectives of this study were to characterize the psychiatric comorbidity of a group of older subacute inpatients and then determine whether their psychiatric comorbidity affected measures of rehabilitation outcomes.

METHODS

Eighty-eight older subacute inpatients were recruited for this prospective study. Psychiatric comorbidity was defined according to a participants' performance on four inventory scales: the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Brief Psychiatric Rating Scale and Health of the Nation Outcome Scale 65+. Rehabilitation outcome referred to the participants' length of stay and their performance at discharge on the EuroQol-5D health-related quality of life questionnaire and Barthel index.

RESULTS

68% of the participants scored in the clinical range on at least one of the four scales assessing psychiatric comorbidity at admission, with 51% in the clinical range for GDS and 32% for the GAI. The decrease in scores by the time of discharge was significant for all four scales. Linear regression analyses pointed to a trend for depressive symptoms at admission to be an influential but nonsignificant predictor of rehabilitation outcome. An interesting association was found between the length of the previous acute admission and the GDS score on admission to the subacute unit.

CONCLUSION

A high prevalence of psychological symptoms was identified upon admission, with a significant decrease by the time of discharge. These factors did not significantly predict the selected measures of rehabilitation outcome. Opportunities for future longitudinal research on the prevalence and impact of psychiatric comorbidities on patient outcomes are considered.

Associated factors of post-stroke depression among Hong Kong Chinese: A longitudinal study

The aim of this study was to explore associated factors of post-stroke depression (PSD) among Chinese first-time stroke patients. A 6-month prospective design was adopted with data collected by face-to-face interviews and physical assessment at two observation time points: T1, within 48 h of admission to the rehabilitation hospitals and T2, 6 months after the first interview in the subject's current place of residence. The prevalence of PSD at T1 and T2 was found to be 69% and 48% respectively. Backward linear regression showed that five variables explained 55% of the variance of PSD at T2. Participants who had a higher level of depression at T2 tended to have a higher level of functional disability, less social companionship and poorer informational support. Those who had been homemaker at pre-morbid state and those who exhibited a higher level of depressive symptoms at T1 showed a higher level of depression at T2. The results of this study suggest that PSD could be a psychological condition arising from the disabling consequences and altered family roles caused by a stroke.

Factors affecting outpatient rehabilitation outcomes in elders

PURPOSE

To identify factors affecting outpatient rehabilitation outcomes in elders.

DESIGN

A retrospective cohort design was used to explore factors affecting outpatient rehabilitation outcomes in elders.

METHODS

Analyses of health records from a nurse-managed comprehensive outpatient rehabilitation facility were conducted. Data pertinent to the study were abstracted from 201 health records, including scores from three standard instruments: the Functional Independence Measure, the Mini-Mental State Examination, and the Geriatric Depression Scale, to construct study variables. Multivariate and stepwise regression analyses were performed.

FINDINGS

Cognitive impairment was associated with lower admission and discharge function, but not with rehabilitation outcomes (functional gain, rehabilitation efficiency, days of service, and discharge location). Age > or = 80 years, admission function, and the interaction of age > or = 80 years and admission function affected functional gain and rehabilitation efficiency. Older age, being Black, and having more medical comorbidities were associated with days of service. None of these factors contributed to discharge location.

CONCLUSIONS

Cognitive impairment was not associated with outpatient rehabilitation outcomes. Rather, age > or = 80 years and function when admitted affected functional gain and rehabilitation efficiency in elders who participated in outpatient rehabilitation services.

Length of hospital stay and health services use of medical inpatients with comorbid noncognitive mental disorders: a review of the literature

We reviewed 23 studies on the association between noncognitive mental disorders and the use of general health care services by medical patients admitted to a general hospital. Only studies with a prospective design and with a correction for possible confounding factors were included. In most studies, only service use during index admission was observed, but eight studies included a longer observation period during follow-up after hospital discharge. The 15 studies that were restricted to service use during index admission showed mixed results: length of hospital stay was related to common mental disorders in some studies, but other studies did not find such an association. The eight studies that used a longer observation period showed findings that are more consistent. They demonstrated mainly that symptoms or complaints of depression are related to a higher resource use within general medical services.

[Prevalence and effects of depressive and anxiety symptoms in internal medicine inpatients during the first year after hospital discharge]

In a prospective follow-up study the German version of the Hospital Anxiety and Depression Scale (HADS) was used to determine the prevalence of anxiety and depressive symptoms in internal medicine inpatients. From a total cohort of 376 admitted study patients questionnaires were completed at admission and after one year follow-up. The data demonstrated that the mean HADS score on the anxiety subscale decreased significantly from 6.7 3.5 at study inclusion to 5.8 3.8 after one year (p < 0.0005) while the mean HADS score on the depression subscale was relatively stable (5.3 3.6 versus 5.4 4.3, p = n.s.). Odds ratios for the prediction of positive HADS results at follow-up were 4.1 (95%-CI 2.0-8.4) for anxiety symptoms and 8.2 (95%-CI 4.6-14.6) for depressive symptoms. Patients with abnormal HADS anxiety scores were significantly more frequently rehospitalized (Odds ratio 1.9; p = 0.028) and also more frequently reported pain symptoms (Odds ratio 2.0; p = 0.019). These results demonstrate the persistence of depressive symptoms and the frequent utilization of health care in internal medicine inpatients with psychiatric disorders in the first year after hospital discharge.