The Psychiatric hospital最新文献

Data are presented that describe the clinical characteristics of 96 patients treated at the C.F. Menninger Memorial Hospital, Topeka, Kansas, from November 1983 to June 1989. Their Axis I eating disorder diagnoses were as follows: 53 had diagnoses of bulimia; 21 had anorexia nervosa; 2 had both diagnoses; 17 had atypical disorders or eating disorders not otherwise specified; and 2 had a diagnosis of psychological factors affecting physical conditions. Seventy-three percent of the cohort were found to have either Axis I or Axis II disorders or both, comorbidity. Borderline personality disorder was found in 46% of the sample, although 20% of the patients with borderline disorders were diagnosed retrospectively. Depression was the largest comorbid Axis I diagnosis. Patient variables for sexual abuse, drug and alcohol addiction, purgative behaviors, and interpersonal relationships are also described. The authors conclude that a substantial subpopulation of eating disordered patients are significantly comorbid for other psychiatric illnesses. This high incidence of comorbidity may help explain the frequency of refractoriness of many eating disordered patients who do not respond to outpatient or short-term inpatient hospitalization. The authors recommend that additional research studies address the problems of the comorbid eating disordered patient and suggest that the findings be taken into account by clinicians and payers.

While most of the recent national attention on healthcare reform has focused on physicians, acute-care hospitals, and the insurance industry, what about mental healthcare providers? Where do psychiatric hospitals, psychiatrists, psychologists, and other mental healthcare professionals fit into the healthcare payment system of the future? For example, if the United States ends up with what is called universal access--a payment source for all Americans--will it include mental health benefits? The stakes are high; one quarter of the American population either has no health insurance or is covered by Medicaid. Many current reform proposals include tort reform; but how would it affect mental healthcare providers? Will managed care--primarily health maintenance organizations (HMOs) and preferred provider organizations (PPOs)--be a part of the reshaping of the United States healthcare system? This article has three objectives: To summarize the various healthcare reform proposals and provide a description of the key elements anticipated in the most likely reform package. To consider the strategic implications of payment reform for the mental healthcare industry. To identify strategies for mental healthcare providers that are likely to be useful regardless of the shape of healthcare reform.

Increasingly, various stakeholders from insurance companies to patients are demanding verification of treatment effectiveness. With this pressure for accountability, program evaluation is essential to the continued existence of psychiatric hospitals because it permits understanding the effects specific interventions or procedures have on the quality and effectiveness of care. Two inpatient aspects of program evaluation are treatment outcome and continuous quality improvement. This article describes the conceptual bases of both treatment outcome and continuous quality improvement, depicts their complementary characteristics, and suggests how these two aspects of program evaluation can be integrated.

Recent and dramatic changes in this country's mental healthcare service are widely documented. To assess the extent and timing of those changes at one private psychiatric hospital, the authors examined length of stay, number of admissions, and patient age for general trends between 1980 and 1990 and more closely examined trends between July 1990 and December 1991. We related our findings to data for other private psychiatric hospitals and compared them with data from psychiatric units in general hospitals. The results are discussed in terms of changes in insurance coverage, changing utilization by different age groups, and a national shift from inpatient to outpatient care.

Child siblings of children admitted to psychiatric hospitals often find themselves in a unique and potentially isolating situation. Because of the crisis affecting all family members and the focus of both parents' and professionals' energies on the identified patient, this sibling group is often overlooked. This paper describes an educational and supportive group designed by the authors to begin to address the needs of this population and offered as part of the family-services component of a child and adolescent psychiatric unit. The group serves multiple functions by diminishing the non-hospitalized children's sense of isolation, offering them education and support, and providing the treatment providers an opportunity to assess the needs of the inpatient's sibling. The authors describe a highly structured format that facilitated group members' participation.

The author applied a twelve-item checklist of criteria for hospitalization to determine the impact of each on length of stay for a group of depressed adolescents admitted to two units of a private child and adolescent psychiatric hospital. Attempts were made to control for the influence of insurance status on time spent in the hospital. Active suicidal preoccupation without active preparation or attempt was the only item found to have significant impact on length of stay.

Informed price setting in private psychiatric hospitals is based on many factors, including accounting cost, economic cost, mission, long-term plans, and competition. Because no single cost accounting method yields the "right" price without the input of judgment and the consideration of other factors, several appropriate and useful methods of cost accounting should be considered. And because various approaches to price setting carry varying degrees of risk, informed price setting must evaluate them all.

The science and marketing of psychiatric treatment are rapidly changing, and the changes are reflected, in part, in the recent evolution of the use of laboratory services. Nevertheless, there are few, if any, articles in the literature addressing how a laboratory service can best assist a psychiatric hospital. This article presents a scaffolding of current issues to be considered when determining how a laboratory can assist the psychiatric facility. It cites the special laboratory needs of the psychiatric hospital and issues to be considered when evaluating laboratory service.

With the increasing pressure from managed care companies and in cooperation with its medical staff's independent practice association, the Vista Hill Foundation formed its own specialty health maintenance organization. This is a report on an outpatient study of treatment satisfaction among 124 mental healthcare providers (50% of whom were psychiatrists) and their 218 patient experiences. Treatment outcome was rated as "very satisfactory" or "satisfactory" in 82% of the studied cases. Managed care was found to cause "mild" to "moderate" treatment interference in 26% of the cases and "significant" to "major" interference in 6%. There was no interference reported in 60% of the cases studied. Our study demonstrates that a hospital provider and its managed care system can provide satisfactory care, but it also reveals the need to constantly review treatment programs to reduce interference. The study and report are part of Vista Hill Foundation's ongoing quality review efforts.

Because of the trend in inpatient psychiatry toward a marked decrease in length of hospitalization, clinicians must reconceptualize the manner in which psychosocial treatments are organized in the inpatient milieu. Considerable data suggest that problem-solving therapies may be a productive way to integrate the groups and activities in the therapeutic milieu. This paper describes the application of a problem-solving approach to the therapeutic milieu and indicates that the therapeutic gains from this approach may be enhanced by combining inpatient treatment with a transitional day hospital program. We identify the empirical underpinnings of this model and describe how it has been used to treat a schizophrenic patient. We suggest that problem-solving therapies are effective for promoting behavioral change on the general psychiatric inpatient unit.