Quality of Inpatient Psychiatric Care at VA, Other Government, Nonprofit, and For-Profit Hospitals: A Comparison
Quality of Inpatient Psychiatric Care at VA, Other Government, Nonprofit, and For-Profit Hospitals: A Comparison
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DOI：
10.1176/appi.ps.201600074
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发表时间：
2017-03-01
影响因子：
3.8
通讯作者：
Rosenthal, Meredith B.
中科院分区：
文献类型：
--
作者：
Shields, Morgan C.;Rosenthal, Meredith B.
目的：对住院精神科护理的质量知之甚少。本研究探讨了住院精神病患者的质量和医院ownership.Methods的七项措施的性能之间的关联：研究设计是一个横断面分析联合委员会的2014年住院精神病医院的质量措施。这些措施评估入院筛查暴力风险、药物使用、心理创伤史和病人实力;隔离和约束的使用;使用多种抗精神病药物的病人出院的做法;在使用多种抗精神病药物的病人出院时提供适当的理由;制定持续护理计划;以及将护理计划传递到下一级护理。参加者是665住院精神病设施认可的联合Commission.Results：平均+/- SD百分比的患者接受入院筛选为90% +/- 21%，多种抗精神病药物在出院时，11% +/- 10%，适当的理由使用多种抗精神病药物在出院时，53% +/- 33%;持续护理计划，88% +/- 22%;将护理计划转移到下一级护理，82% +/-23%。每1,000患者小时使用约束0.32 +/- 1.1小时，每1,000患者小时使用隔离0.27 +/-0.8小时。医院在特定指标上的表现不一定能预测其他指标的表现。政府医院表现不佳，由美国退伍军人管理局（VA）执行worst.Conclusions：缺乏跨措施的相关性表明，无论是住院精神科护理质量是多方面的，或者它是不可靠的评估。医院所有权强烈预测性能，VA医院在大多数措施中表现相对较差。
Objective: Little is known about the quality of inpatient psychiatric care. This study examined associations between performance on seven measures of inpatient psychiatric quality and hospital ownership.Methods: The study design was a cross-sectional analysis of The Joint Commission's 2014 inpatient psychiatric hospital quality measures. The measures evaluate admission screening for violence risk, substance use, psychological trauma history, and patient strengths; use of seclusion and restraint; the practice of discharging patients on multiple antipsychotics; providing appropriate justification when patients are discharged on multiple antipsychotics; creation of continuing care plans; and transmission of care plans to the next level of care. Participants were 665 inpatient psychiatric facilities accredited by The Joint Commission.Results: The mean +/- SD percentage of patients who received admission screening was 90% +/- 21%; multiple antipsychotics at discharge, 11% +/- 10%; appropriate justification for use of multiple antipsychotics at discharge, 53% +/- 33%; a continuing care plan, 88% +/- 22%; and transmission of the care plan to the next level of care, 82% +/- 23%. Restraint was used for.32 +/- 1.1 hours per 1,000 patient hours, and seclusion was used for.27 +/-.8 hours per 1,000 patient hours. Hospital performance on a given measure did not necessarily predict performance on other measures. Government hospitals were low performers, and hospitals owned by the U.S. Department of Veterans Administration (VA) performed worst.Conclusions: Lack of correlation across measures suggests either that inpatient psychiatric care quality is multidimensional or that it is unreliably assessed. Hospital ownership strongly predicted performance, and VA hospitals performed relatively poorly across most measures.