Psychiatric co-morbidity and hospital utilization in the general medical sector

1999 ◽  
Vol 29 (2) ◽  
pp. 457-464 ◽  
Author(s):  
ELIZABETH SAVOCA
Keyword(s):  
Psychiatric Disorders ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Disabled Persons ◽  
Economic Evaluations ◽  
Medical Conditions ◽  
Medical Sector ◽  
Co Morbidity ◽  
Wide Range ◽  
Hospital Use

Background. This article provides evidence about the relationship between psychiatric disorders, physical disorders and hospital use in the general medical sector using a broadly based survey of the US population.Methods. The data are from the 1989 National Health Interview Survey. This survey contains medical and mental health evaluations for the entire sample. In a multivariate framework, the author estimates the effect of mental illness on the probability of being admitted to a general hospital, the number of admissions and the length of stay.Results. Hospital use in the general medical sector is significantly higher for persons with coexisting physical and psychiatric conditions than for those with no psychiatric disorders. For a wide range of medical conditions, the predicted number of hospital admissions and the length of a hospital stay increase substantially when the physical illness is accompanied by a psychiatric condition.Conclusions. One implication of this finding is that economic evaluations of alternative psychiatric treatments should consider any differences in hospital costs related to the treatment of coexisting medical conditions. Another implication pertains to health care systems where insurers have some discretion over which individuals to insure. In the absence of adequate adjustments in insurance payments for high-risk potential enrollees, psychiatrically disabled persons may have more limited access to health insurance.

Disability and psychiatric disorders in an urban community: measurement, prevalence and outcomes

1998 ◽  
Vol 28 (3) ◽  
pp. 509-517 ◽  
Author(s):  
S. S. BASSETT ◽  
G. A. CHASE ◽  
M. F. FOLSTEIN ◽  
D. A. REGIER
Keyword(s):  
Psychiatric Disorders ◽  
Service Utilization ◽  
Adult Population ◽  
Diagnostic Category ◽  
Psychiatric Evaluation ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Sampling Weights ◽  
Co Morbidity ◽  
Specific Disability

Background. The purpose of this analysis was to examine: (1) the prevalence of psychiatric disorders among disabled people, using seven different measures of disability; (2) variation in disability between and within psychiatric diagnostic categories; and (3) relationship of diagnosis and disability to health service utilization.Method. Data were drawn from Phase I and Phase II of the Eastern Baltimore Mental Health Survey, part of the Epidemiologic Catchment Area Program (ECA) conducted in 1980–1 to survey mental morbidity within the adult population. A total of 810 individuals received both a household interview and a standardized clinical psychiatric evaluation. Estimated prevalence rates were computed using appropriate survey sampling weights.Results. Prevalence of disability ranged from 2·5 to 19·5%, varying with specific disability measure. Among those classified as disabled by any of the measures examined, 56 to 92% had a psychiatric disorder and serious chronic medical conditions were present in the majority of these cases (54 to 78%). Disability was expressed differently among the various diagnostic groups. Diagnostic category and disability were significant independent predictors of medical service utilization and receipt of disability payments.Conclusions. The majority of disabled adults living in the community have diagnosable psychiatric disorders, with the majority of these individuals suffering from significant chronic medical conditions as well, thus making co-morbidity the norm.

Assessing the Need to Hospitalize Children: Pediatric Appropriateness Evaluation Protocol

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 242-247
Author(s):  
Bernard E. Kreger ◽  
Joseph D. Restuccia
Keyword(s):  
Hospital Admissions ◽  
Hospital Costs ◽  
Hospitalized Patients ◽  
Pediatric Hospital ◽  
Medical Necessity ◽  
Appropriateness Evaluation Protocol ◽  
Evaluation Protocol ◽  
Hospital Use

Rapidly increasing hospital costs have necessitated use review of hospitalized patients to improve the appropriateness (medical necessity) of hospital use. The development and testing of the Pediatric Appropriateness Evaluation Protocol, an objective, criteria-based instrument intended to assist physicians and use reviewers in making decisions regarding appropriateness of pediatric hospital admissions and days of care, are described.

scholarly journals The placebo effect

2006 ◽  
Vol 30 (5) ◽  
pp. 185-188 ◽  
Author(s):  
Sundararajan Rajagopal
Keyword(s):  
Clinical Practice ◽  
Psychiatric Disorders ◽  
Placebo Effect ◽  
Ethical Dilemmas ◽  
Medical Conditions ◽  
Wide Range ◽  
The Common

The placebo effect is a fascinating phenomenon in clinical practice. Studies have shown that there is a significant placebo effect in a wide range of medical conditions including psychiatric disorders. This article looks at the background of the placebo effect, defines the common terms used, describes the various hypotheses that have been put forward to explain this seemingly inexplicable phenomenon and also covers the issue of using placebos in research trials, highlighting the important ethical dilemmas involved. Throughout, specific emphasis is given to psychiatry.

Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview

2007 ◽  
Vol 38 (2) ◽  
pp. 199-210 ◽  
Author(s):  
M. Zimmerman ◽  
J. B. McGlinchey ◽  
I. Chelminski ◽  
D. Young
Keyword(s):  
Psychiatric Disorders ◽  
Rhode Island ◽  
Present Report ◽  
Post Traumatic Stress ◽  
Principal Diagnosis ◽  
Epidemiological Surveys ◽  
Co Morbidity ◽  
Wide Range ◽  
Axis I ◽  
Dsm Iv

BackgroundThe largest clinical epidemiological surveys of psychiatric disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is the largest clinical epidemiological study using semi-structured interviews assessing a wide range of psychiatric disorders conducted in a general clinical out-patient practice. In the present report we examined the frequency of DSM-IV Axis I diagnostic co-morbidity in psychiatric out-patients.MethodA total of 2300 out-patients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) upon presentation for treatment.ResultsThe mean number of current and lifetime DSM-IV Axis I disorders in the 2300 patients was 1.9 (s.d.=1.5) and 3.0 (s.d.=1.8) respectively. The majority of patients were diagnosed with two or more current disorders, and more than one-third were diagnosed with three or more current disorders. Examination of the most frequent current disorders in the patients with the 12 most common principal diagnoses indicated that the pattern of co-morbidity differed among the disorders. The highest mean number of current co-morbid disorders was found for patients with a principal diagnosis of post-traumatic stress disorder and bipolar disorder.ConclusionsClinicians should assume that psychiatric patients presenting for treatment have more than one current diagnosis. The pattern of co-morbidity varies according to the principal diagnosis.

scholarly journals Measuring unexplained variation in acute hospital use by patients enrolled with northern New Zealand general practices

2014 ◽  
Vol 6 (2) ◽  
pp. 93 ◽  
Author(s):  
Peter Sandiford ◽  
Lifeng Zhou ◽  
Micol Salvetto ◽  
Lannes Johnson
Keyword(s):  
Access To Health Care ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Practice Variation ◽  
Acute Hospital ◽  
Patient Admissions ◽  
Travelling Time ◽  
General Practices ◽  
Health Services Needs ◽  
Hospital Use

INTRODUCTION: There is increasing concern worldwide at the steady growth in acute inpatient admissions and emergency department (ED) attendances. AIM: To develop measures of variation in acute hospital use between populations enrolled at different general practices that are independent of the sociodemographic characteristics of those populations. METHODS: Two consecutive years of hospital discharge and ED attendance data were combined with primary health organisation (PHO) registers from 385 practices of over 1.5 million people to develop and test two measures of unplanned hospital use: the standardised acute hospital admission ratio (SAAR) and the standardised ED attendance ratio (SEAR). Disease-specific measures were also produced for inpatient events. RESULTS: The enrolled populations of a high proportion of practices had significantly higher or lower than expected acute use of hospitals and this was consistent over both years studied. Practices whose population made unexpectedly high use of acute hospital care for one condition tended to do so for others. Differences in health needs between practice populations as measured by clinical complexity, comorbidities and length of stay did not explain a significant portion of the overall variation in hospital admissions. The enrolled population’s average travelling time to a 24-hour ED accounted for some of the practice variation in unplanned utilisation of hospital services. DISCUSSION: This study confirms that there is considerable unexplained practice variation in acute hospital use. Further development of the SAAR and SEAR measures may be possible to use these to identify modifiable practice-level factors associated with high unplanned hospital use. KEYWORDS: Access to health care; emergency medical services; general practice; health services needs and demand; hospital costs; patient admissions

Length of Stay in Pediatric Neurology Hospital Admissions

2021 ◽  
pp. 088307382110208
Author(s):  
Annie Roliz ◽  
Yash D. Shah ◽  
Sanjeev Kothare ◽  
Kanwaljit Singh ◽  
Sushil Talreja
Keyword(s):  
Length Of Stay ◽  
Psychiatric Disorders ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Neurologic Disorder ◽  
Prolonged Length ◽  
Inpatient Hospital ◽  
Icu Admission ◽  
Unplanned Admissions ◽  
Pediatric Icu

Objective: To describe inpatient length of stay patterns, identify key drivers related to prolonged length of stay, and evaluate the relationship between length of stay and readmission in pediatric neurology Methods: This was a retrospective review of patients <19 years old admitted with a principal neurologic diagnosis to our hospital between January 2017 and July 2019. Scheduled admissions and hospital admissions lasting >30 days were excluded from analysis. Length of stay was obtained in addition to demographic characteristics, principal discharge diagnosis, multispecialty care, use of multiple antiseizure medications, inpatient hospital costs (ie, claims paid), and pediatric intensive care unit (ICU) admission for unplanned admissions and 7- and 30-day readmissions. Results: There were a total of 1579 unplanned admissions. The most common reasons for admission were seizure (n = 942), headache (n = 161), other neurologic diagnosis (n = 121), and psychiatric disorders/functional neurologic disorder (n = 60). Children admitted to the hospital for a neurologic condition have an average length of stay of 2.8±5.0 days for unplanned admissions, 4.5±7.4 days for 7-day readmissions, and 5.2±7.5 days for 30-day readmissions. Average inpatient hospital costs were $44 075±56 976 for unplanned admissions, $60 361±71 427 for 7-day readmissions, and $55 434±56 442 for 30-day readmissions. Prolonged length of stay and increased hospital costs were associated with pediatric ICU admission, multispecialty care, 7- and 30-day readmission, multiple antiseizure medications, and psychiatric disorders / functional neurologic disorders. Conclusions: Pediatric ICU admission, multispecialty care, readmission, multiple antiseizure medications, and psychiatric disorder / functional neurologic disorder prolong length of stay and increase hospital costs.

RepPer: Perception of Psychiatric Disorders on Twitter in French (Preprint)

2020 ◽  
Author(s):  
Sarah Delanys ◽  
Farah Benamara ◽  
Véronique Moriceau ◽  
François Olivier ◽  
Josiane Mothe
Keyword(s):  
Social Media ◽  
Psychiatric Disorders ◽  
Digital Technology ◽  
Psychotic Disorders ◽  
Negative Polarity ◽  
Machine Learning Algorithms ◽  
Annotation Scheme ◽  
Word Use ◽  
Wide Range ◽  
Initial Dataset

BACKGROUND With the advent of digital technology and specifically user generated contents in social media, new ways emerged for studying possible stigma of people in relation with mental health. Several pieces of work studied the discourse conveyed about psychiatric pathologies on Twitter considering mostly tweets in English and a limited number of psychiatric disorders terms. This paper proposes the first study to analyze the use of a wide range of psychiatric terms in tweets in French. OBJECTIVE Our aim is to study how generic, nosographic and therapeutic psychiatric terms are used on Twitter in French. More specifically, our study has three complementary goals: (1) to analyze the types of psychiatric word use namely medical, misuse, irrelevant, (2) to analyze the polarity conveyed in the tweets that use these terms (positive/negative/neural), and (3) to compare the frequency of these terms to those observed in related work (mainly in English ). METHODS Our study has been conducted on a corpus of tweets in French posted between 01/01/2016 to 12/31/2018 and collected using dedicated keywords. The corpus has been manually annotated by clinical psychiatrists following a multilayer annotation scheme that includes the type of word use and the opinion orientation of the tweet. Two analysis have been performed. First a qualitative analysis to measure the reliability of the produced manual annotation, then a quantitative analysis considering mainly term frequency in each layer and exploring the interactions between them. RESULTS One of the first result is a resource as an annotated dataset . The initial dataset is composed of 22,579 tweets in French containing at least one of the selected psychiatric terms. From this set, experts in psychiatry randomly annotated 3,040 tweets that corresponds to the resource resulting from our work. The second result is the analysis of the annotations; it shows that terms are misused in 45.3% of the tweets and that their associated polarity is negative in 86.2% of the cases. When considering the three types of term use, 59.5% of the tweets are associated to a negative polarity. Misused terms related to psychotic disorders (55.5%) are more frequent to those related to mood disorders (26.5%). CONCLUSIONS Some psychiatric terms are misused in the corpora we studied; which is consistent with the results reported in related work in other languages. Thanks to the great diversity of studied terms, this work highlighted a disparity in the representations and ways of using psychiatric terms. Moreover, our study is important to help psychiatrists to be aware of the term use in new communication media such as social networks which are widely used. This study has the huge advantage to be reproducible thanks to the framework and guidelines we produced; so that the study could be renewed in order to analyze the evolution of term usage. While the newly build dataset is a valuable resource for other analytical studies, it could also serve to train machine learning algorithms to automatically identify stigma in social media.

scholarly journals Emergency hospital admissions for psychiatric disorders in a German-wide hospital network during the COVID-19 outbreak

2021 ◽  
Author(s):  
Jonathan Mathias Fasshauer ◽  
Andreas Bollmann ◽  
Sven Hohenstein ◽  
Gerhard Hindricks ◽  
Andreas Meier-Hellmann ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Hospital Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions

The outcomes of emergency hospital admissions with non-malignant upper gastrointestinal bleeding in England between 2003 and 2015

Endoscopy ◽  
2021 ◽  
Author(s):  
James Rees ◽  
Felicity Evison ◽  
Jemma Mytton ◽  
Prashant Patel ◽  
Nigel Trudgill
Keyword(s):  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Key Management ◽  
Hospital Admissions ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Emergency Admissions ◽  
Co Morbidity ◽  
Standardized Mortality Rate ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant mortality. Despite developments in endoscopic and clinical management, only minor improvements in outcomes have been reported. Methods This was a retrospective cohort study of patients with non-malignant UGIB emergency admissions in England between 2003 and 2015, using Hospital Episode Statistics. Multilevel logistic regression analysis examined the associations with mortality. Results 242 796 patients with an UGIB admission were identified (58.8 % men; median age 70 [interquartile range (IQR) 53 – 81]). Between 2003 and 2015, falls occurred in both 30-day mortality (7.5 % to 7.0 %; P < 0.001) and age-standardized mortality (odds ratio (OR) 0.74, 95 % confidence interval [CI] 0.69 – 0.80; P < 0.001), including from variceal bleeding (OR 0.63, 95 %CI 0.45 – 0.87; P < 0.005). Increasing co-morbidity (Charlson score > 5, OR 2.94, 95 %CI 2.85 – 3.04; P < 0.001), older age (> 83 years, OR 6.50, 95 %CI 6.09 – 6.94; P < 0.001), variceal bleeding (OR 2.03, 95 %CI 1.89 – 2.18; P < 0.001), and a weekend admission (Sunday, OR 1.18, 95 %CI 1.12 – 1.23; P < 0.001) were associated with 30-day mortality. Of deaths at 30 days, 8.9 % were from ischemic heart disease (IHD) and the cardiovascular age-standardized mortality rate following UGIB was high (IHD deaths within 1 year, 1188.4 [95 %CI 1036.8 – 1353.8] per 100 000 men in 2003). Conclusions Between 2003 and 2015, 30-day mortality among emergency admissions with non-malignant UGIB fell by 0.5 % to 7.0 %. Mortality was higher among UGIB admissions at the weekend, with important implications for service provision. Patients with UGIB had a much greater risk of subsequently dying from cardiovascular disease and addressing this risk is a key management step in UGIB.

Self-reports of health-care utilization: Diary or questionnaire?

2005 ◽  
Vol 21 (3) ◽  
pp. 298-304 ◽  
Author(s):  
Mandy van den Brink ◽  
Wilbert B. van den Hout ◽  
Anne M. Stiggelbout ◽  
Hein Putter ◽  
Cornelis J. H. van de Velde ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Convergent Validity ◽  
Cost Utility ◽  
Care Utilization ◽  
Economic Evaluations ◽  
Cost Diary ◽  
Open Questions ◽  
Wide Range ◽  
More Care

Objectives:The feasibility and convergent validity of a cost diary and a cost questionnaire was investigated.Methods:Data were obtained as part of a cost-utility analysis alongside a multicenter clinical trial in patients with resectable rectal cancer. A sample of 107 patients from 30 hospitals was asked to keep a weekly diary during the first 3 months after surgery, and a monthly diary from 3 to 12 months after surgery. A second sample of seventy-two patients from twenty-eight hospitals in the trial received a questionnaire at 3, 6, and 12 months after surgery, referring to the previous 3 or 6 months. Format and items of the questions were similar and included a wide range of medical and nonmedical items and costs after hospitalization for surgery.Results:Small differences were found with respect to nonresponse (range, 79 to 86 percent) and missing questions (range, 1 to 6 percent between the diary and questionnaire). For most estimates of volumes of care and of costs, the diary and questionnaire did not differ significantly. Total 3-month nonhospital costs were €1,860, €1,280, and €1,050 in the diary sample and €1,860, €1,090, and €840 in the questionnaire sample at 3, 6, and 12 months after surgery, respectively (p=.50). However, with respect to open questions, the diary sample tended to report significantly more care.Conclusions:For the assessment of health-care utilization in economic evaluations alongside clinical trials, a cost questionnaire with structured closed questions may replace a cost diary for recall periods up to 6 months.

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