A brief medical neccssity scale for mental disorders: Reliability, validity, and clinical utility

Abstract

Managed care organizations (MCOs) use the concept of "medical necessity" to decide whether a prescribed treatment is warranted for a given medical condition. Because mental disorders lack the objective disease criteria common to medical illness, behavioral health administrators need a validated means to identify and quantify the severity of "medically important" aspects of mental disorders. The authors developed and tested a brief medical necessity scale for mental disorders in 205 patients presenting for initial evaluation. The scale had a factor structure with four subscales; good internal consistency, interrater reliability, and concurrent and predictive validity; and modest ability to identify patients requiring hospitalization and, in hospitalized patients, those requiring involuntary hospitalization. The authors propose use of the scale to better clarify decisions about level of care assignments and to better assess patient characteristics predictive of good outcome.

Geriatric Patients Improve as Much as Younger Patients from Hospitalization on General Psychiatric Units

“…The Harborview modification has added items for substance abuse and an ordinal rating (0-6) of medical illness severity with specific disease anchors that has been validated against the chronic disease score. [17][18][19][20] Medical illness severity was dichotomized into those with mild (0-3) and moderate-to-severe ( !3) medical illness. The PSAS was completed on admission to and discharge from the psychiatric unit.…”

Use of Psychiatric Emergency Services and Enrollment Status in a Public Managed Mental Health Care Plan

“…The 2,419 patients had a DSM-IV psychiatric diagnosis, as determined by a semistructured interview. The Emergency Trauma Center Assessment Form, which has been found to be valid and reliable (11), was completed during each patient's evaluation and provided scaled ratings for 11 variables. Clinical psychiatric variables included psychosis, depression, anxiety, hostility, uncooperativeness, and suicidality.…”

Characteristics of HIV-Positive Patients Treated in a Psychiatric Emergency Department

“…At each visit, clinicians completed a previously validated assessment form that ascertains demographic information and ratings of presenting psychiatric symptoms and provides clinician-rated DSM-IV diagnoses (2). The demographic information included gender, age, race, and residential status.…”