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Abstract

Objective:

Rural residents have higher rates of serious mental illness than urban residents, but little is known about the quality of inpatient psychiatric care available to them locally or how quality may have changed in response to federal initiatives. This study aimed to examine differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals.

Methods:

This national retrospective study of 1,644 facilities examined facility-level annual quality-of-care data from the Inpatient Psychiatric Facility Quality Reporting program, 2015–2019. Facility location was categorized as urban, large rural, or small or isolated rural on the basis of zip code–level rural-urban commuting area codes. Generalized regression models were used to assess rural-urban differences in care quality (five continuity-of-care and two patient experience measures) and changes over time.

Results:

Rural inpatient psychiatric units performed better than urban units in nearly all domains. Improvements in quality of care (excluding follow-up care) were similar in rural and urban units. Rates of 30- and 7-day postdischarge follow-up care decreased in all hospitals but faster in rural units. Timely transmission of transition records was more frequent in small or isolated rural versus urban units (mean marginal difference=22.5, 95% CI=6.3–38.8). Physical restraint or seclusion use was less likely in rural than in urban units (OR=0.6, 95% CI=0.5–0.8).

Conclusions:

Rural psychiatric units had better care quality at baseline (better follow-up care, better timely transmission of transition records, and lower rates of physical restraint use) than urban units, but during 2015–2019, follow-up care performance decreased overall and more in rural than urban units.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 446 - 454
PubMed: 36321319

History

Received: 25 May 2022
Revision received: 19 July 2022
Accepted: 23 August 2022
Published online: 2 November 2022
Published in print: May 01, 2023

Keywords

  1. Rural health
  2. Psychiatric care
  3. Quality of care
  4. Rural psychiatric services
  5. Inpatient treatment
  6. Mental health systems

Authors

Details

Peiyin Hung, Ph.D., M.S.P.H. [email protected]
Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth).
Janice C. Probst, Ph.D.
Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth).
Yiwen Shih, M.D., M.P.H.
Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth).
Radhika Ranganathan, M.Phil.
Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth).
Monique J. Brown, Ph.D., M.P.H.
Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth).
Elizabeth Crouch, Ph.D.
Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth).
Jan M. Eberth, Ph.D.
Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth).

Notes

Send correspondence to Dr. Hung ([email protected]).

Competing Interests

Dr. Brown is the cofounder of Brown Research Consulting Inc. The other authors report no financial relationships with commercial interests.

Funding Information

This study was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (DHHS) (grant number U1C45498, Rural Health Research Grant Program Cooperative Agreement).The information or content and conclusions in this article are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, DHHS, or the U.S. government.

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