Inpatient Psychiatric Care Experience and Its Relationship to Posthospitalization Treatment Participation
Abstract
Objective
Methods
Results
Conclusions
Methods
Study population and data sources
I-SHEP
Measures
Analyses
Results
I-SHEP responders (N=7,408) | I-SHEP nonresponders (N=26,829) | All patients (N=65,775) | ||||||
---|---|---|---|---|---|---|---|---|
Characteristic | N | % | N | % | χ2b | df | N | % |
Male | 6,742 | 91.0 | 24,669 | 92.0 | 6.76* | 1 | 59,960 | 91.4 |
African American | 1,708 | 23.1 | 7,567 | 28.2 | 79.07* | 1 | 16,893 | 27.0 |
Hispanic ethnicity | 247 | 3.3 | 800 | 3.0 | 2.43 | 1 | 2050 | 3.2 |
Prehospitalization mental health visit | 6,215 | 83.9 | 21,736 | 81.0 | 32.10* | 52,415 | 79.7 | |
Postdischarge mental health visit | ||||||||
Within 7 days | 5,201 | 70.2 | 17,924 | 66.8 | 30.60* | 1 | 41,430 | 63.0 |
Within 30 days | 6,611 | 89.2 | 22,583 | 84.2 | 118.69* | 1 | 53,247 | 81.0 |
Age | ||||||||
18–44 | 1,091 | 14.7 | 7,426 | 27.7 | 17,339 | 26.4 | ||
45–65 | 5,460 | 73.7 | 17,349 | 64.7 | 41,670 | 63.6 | ||
>65 | 857 | 11.6 | 2,054 | 7.7 | 567.16* | 2 | 6,562 | 10.0 |
Diagnosis | ||||||||
Major depressive disorder | 1,920 | 25.9 | 5,344 | 19.9 | 124.99* | 1 | 14,197 | 21.6 |
Posttraumatic stress disorder | 2,462 | 33.2 | 6,943 | 25.9 | 157.64* | 1 | 17,772 | 27.0 |
Substance use disorder | 3,504 | 47.3 | 15,816 | 59.0 | 320.50* | 1 | 36,428 | 55.4 |
Bipolar disorder | 1,248 | 16.9 | 4,652 | 17.3 | .99 | 1 | 11,097 | 16.9 |
Schizophrenia spectrum disorders | 1,120 | 15.1 | 4,914 | 18.3 | 40.87* | 1 | 11,185 | 17.0 |
Personality disorder | 740 | 10.0 | 3,298 | 12.3 | 29.61* | 1 | 7,446 | 11.3 |
Medical comorbidity (CCI scorec) | ||||||||
0 | 4,448 | 60.0 | 17,378 | 64.8 | 41,277 | 62.8 | ||
1 | 1,984 | 26.8 | 6,451 | 24.0 | 15,942 | 24.2 | ||
>1 | 976 | 13.2 | 3,000 | 11.2 | 57.88* | 2 | 8,556 | 13.0 |
Inpatient treatment (days) | ||||||||
<7 | 3,246 | 43.8 | 11,488 | 42.8 | 28,191 | 42.9 | ||
7–14 | 2,828 | 38.2 | 10,243 | 38.2 | 24,308 | 37.0 | ||
>14 | 1,334 | 18.0 | 5,098 | 19.0 | 4.40 | 2 | 13,276 | 20.2 |
Distance to hospital (miles) | ||||||||
<30 | 6,728 | 91.1 | 24,839 | 92.8 | 60,602 | 92.5 | ||
30–60 | 610 | 8.3 | 1,808 | 6.8 | 4,609 | 7.0 | ||
>60 | 50 | .7 | 113 | .4 | 28.19* | 2 | 333 | .5 |
Factor analysis
Factor | |||
---|---|---|---|
Item | Hospital-nurses | Care information | Doctors |
How often did nurses show respect for what you had to say? | .74 | −.28 | .27 |
How often did you feel nurses really cared about you as a person? | .74 | −.30 | .24 |
How often did nurses listen carefully to you? | .73 | −.24 | .25 |
How often did nurses treat you with courtesy and respect? | .73 | −.20 | .20 |
What number, from 0 to 10, would you use to rate this hospital? | .70 | −.35 | .27 |
Would you recommend this hospital to your friends and family? | .66 | −.35 | .24 |
How often did nurses explain things in a way you could understand? | .65 | −.26 | .28 |
If you could have free care outside the Department of Veterans Affairs, would you choose to be hospitalized here again? | .57 | −.35 | .22 |
How often did health care providers seem informed, up to date about your care? | .52 | −.41 | .31 |
How often was personal information about you treated in a confidential manner? | .51 | −.29 | .31 |
How often were your room and bathroom kept clean? | .48 | −.15 | .15 |
Did you have a complaint about how you were treated (medically or personally)? | .43 | −.25 | .24 |
How often was the area around your room quiet at night? | .43 | −.11 | .18 |
Were there times when you were confused because different providers told you different things? | .41 | −.29 | .34 |
Did providers give you complete and accurate information about your plan of care? | −.17 | .69 | −.18 |
Did providers give you complete and accurate information about your treatment? | −.20 | .68 | −.21 |
Did providers talk with you about the pros and cons of each choice for your treatment or health care? | −.23 | .66 | −.18 |
Did providers give you complete and accurate information about choices for your care? | −.16 | .62 | −.13 |
When there was more than one treatment choice, did providers ask which choice you thought was best? | −.23 | .61 | −.17 |
Did providers give you complete and accurate information about your medications? | −.22 | .59 | −.18 |
Did providers give you complete and accurate information about side effects of your medications? | −.23 | .59 | −.10 |
Did providers give you complete and accurate information about follow-up care? | −.19 | .58 | −.19 |
Did someone on the hospital staff tell you what activities you could do after you got home? | −.23 | .56 | −.13 |
Did you get information in writing about what symptoms or health problems to look for after you left the hospital? | −.18 | .52 | −.15 |
Did hospital staff talk with you about whether you would have the help you needed when you left the hospital? | −.21 | .51 | −.19 |
Did you know who to contact if you needed medical advice or help right away, after you went home? | −.20 | .42 | −.20 |
Did you know who to ask when you had questions about your health care? | −.38 | .41 | −.28 |
How often did doctors listen carefully to you? | .37 | −.28 | .75 |
How often did doctors show respect for what you had to say? | .40 | −.33 | .72 |
How often did doctors treat you with courtesy and respect? | .39 | −.25 | .71 |
How often did you feel doctors really cared about you as a person? | .42 | −.35 | .68 |
How often did doctors explain things in a way you could understand? | .39 | −.31 | .66 |
Factor evaluation
Factor | ||||||
---|---|---|---|---|---|---|
Hospital-nurses | Care information | Doctors | ||||
Variable | β | SE | β | SE | β | SE |
Male | .97 | .35** | .74 | .45 | .06 | .15 |
African American | .05 | .25 | .63 | .31* | .20 | .11 |
Hispanic ethnicity | 2.03 | .55** | 1.23 | .70 | 1.11 | .24** |
Prehospitalization mental health visit | -.44 | .28 | −.5 | .35 | −.22 | .12 |
Age (reference: <45) | ||||||
45–65 | 1.32 | .26** | .19 | .33 | .46 | .11** |
>65 | 1.84 | .42** | −.88 | .54 | .66 | .19** |
Diagnosis | ||||||
Major depressive disorder | −.17 | .25 | .32 | .32 | .07 | .11 |
Posttraumatic stress disorder | −.88 | .22** | −.33 | .29 | −.22 | .10* |
Substance use disorder | −.34 | .22 | .11 | .28 | −.32 | .10** |
Bipolar disorder | −.31 | .28 | −.25 | .36 | .06 | .12 |
Schizophrenia spectrum disorder | −.18 | .31 | −.56 | .39 | .07 | .13 |
Personality disorder | −1.28 | .33** | −1.62 | .42** | −.82 | .15** |
Medical comorbidity (reference: CCI score=0)b | ||||||
1 | .26 | .24 | .13 | .31 | .17 | .11 |
≥2 | .24 | .33 | .16 | .42 | .08 | .15 |
Inpatient treatment (reference: <7 days) | ||||||
7–14 | .34 | .23 | .61 | .29* | .18 | .10 |
>14 | .16 | .30 | 1.41 | .38** | <.01 | .13 |
Distance to hospital (reference: <30 miles) | ||||||
30–60 | .04 | .38 | −.89 | .48 | −.27 | .17 |
>60 | −.69 | 1.24 | .42 | 1.57 | −.01 | .54 |
Posthospitalization mental health treatment participation
7-day follow-up | 30-day follow-up | |||
---|---|---|---|---|
Inpatient care factor and patient characteristics | Odds ratio | 95% CI | Odds ratio | 95% CI |
Inpatient careb | ||||
Hospital-nurses | .96 | .88–1.05 | .99 | .87–1.12 |
Care information | 1.14 | 1.06–1.22** | 1.17 | 1.05–1.29** |
Doctors | 1.01 | .93–1.09 | 1.02 | .91–1.15 |
Male | .80 | .66–.97* | .88 | .64–1.21 |
African American | .80 | .71–.91** | .66 | .56–.79** |
Hispanic ethnicity | 1.28 | .95–1.73 | 1.17 | .72–1.88 |
Mental health visit ≤90 days prehospitalization | 2.07 | 1.82–2.36** | 2.36 | 1.99–2.81** |
Age (reference: <45) | ||||
45–65 | .92 | .81–1.06 | .74 | .60–.92** |
>65 | .72 | .58–.88** | .49 | .36–.67** |
Diagnosis | ||||
Major depressive disorder | 1.48 | 1.29–1.69** | 2.07 | 1.66–2.59** |
Posttraumatic stress disorder | 1.07 | .96–1.21 | 1.30 | 1.08–1.56** |
Substance use disorder | .93 | .83–1.04 | .66 | .55–.78** |
Bipolar disorder | 1.30 | 1.12–1.51** | 1.64 | 1.29–2.09** |
Schizophrenia spectrum disorder | 1.13 | .97–1.32 | 1.15 | .91–1.45 |
Personality disorder | .95 | .80–1.12 | 1.25 | .95–1.64 |
Medical comorbidity (reference: CCI score=0)c | ||||
1 | .81 | .72–.92** | .83 | .69–.99* |
≥2 | .78 | .66–.92** | .86 | .68–1.10 |
Inpatient treatment (reference: <7 days) | ||||
7–14 | 1.05 | .93–1.18 | 1.28 | 1.08–1.53** |
>14 | .92 | .79–1.07 | 1.10 | .87–1.38 |
Distance to hospital (reference: <30 miles) | ||||
30–60 | .84 | .70–1.02 | .86 | .65–1.13 |
>60 | .65 | .36–1.18 | .35 | .17–.72** |
Discussion
Factor evaluation
Relationships between factors and postinpatient treatment
Conclusions
Acknowledgments and disclosures
References
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