Subgroups of Frequent Users of an Inpatient Mental Health Program at a Community Hospital in Canada

Fisher, Susan G.; Stevens, Robert F.

doi:10.1176/ps.50.2.244

Cited by 30 publications

(30 citation statements)

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“…4,8 Disproportionate use of health care services by a segment of the population has been identified as a challenge in many countries, including Canada. [9][10][11][12] To encourage less resource-intensive care for frequent users, many efforts have been implemented. Some of these interventions, for example, have been designed specifically to transition health care utilization away from the hospital to other settings, such as community-based clinics.…”

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confidence: 99%

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Tricco

Antony

Ivers

et al. 2014

CMAJ

131

101

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Background: Frequent users of health care services are a relatively small group of patients who account for a disproportionately large amount of health care utilization. We conducted a metaanalysis of the effectiveness of interventions to improve the coordination of care to reduce health care utilization in this patient group. Methods:We searched MEDLINE, Embase and the Cochrane Library from inception until May 2014 for randomized clinical trials (RCTs) assessing quality improvement strategies for the coordination of care of frequent users of the health care system. Articles were screened, and data abstracted and appraised for quality by 2 reviewers, independently. Random effects meta-analyses were conducted. Results:We identified 36 RCTs and 14 companion reports (total 7494 patients). Significantly fewer patients in the intervention group than in the control group were admitted to hospital (relative risk [RR] 0.81, 95% confidence interval [CI] 0.72-0.91). In subgroup analyses, a similar effect was observed among patients with chronic medical conditions other than mental illness, but not among patients with mental illness. In addition, significantly fewer patients 65 years and older in the intervention group than in the control group visited emergency departments (RR 0.69, 95% CI 0.54-0.89). Interpretation:We found that quality improvement strategies for coordination of care reduced hospital admissions among patients with chronic conditions other than mental illness and reduced emergency department visits among older patients. Our results may help clinicians and policy-makers reduce utilization through the use of strategies that target the system (team changes, case management) and the patient (promotion of self-management). AbstractSee related commentary, www.cmaj.ca/lookup

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confidence: 99%

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Tricco

Antony

Ivers

et al. 2014

CMAJ

131

101

View full text Add to dashboard Cite

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“…Cluster analysis has often been used to create typologies of individuals with severe mental disorders only (Casper & Donaldson 1990;Fisher & Stevens 1999;Fleury et al 2011;Lora et al 2001;Luke et al 1996;Rubin & Panzano 2002) or co-occurring mental and substance abuse disorders (Beitchman et al 2001;Castel et al 2006;Leggio et al 2009). To our knowledge, however, no study has yet been published on substance dependence with or without co-occurring mental disorders.…”

Section: Introductionmentioning

confidence: 99%

Typology of Individuals with Substance Dependence Based on a Montreal Longitudinal Catchment Area Study

Fleury

Grenier

Bamvita

et al. 2014

Adm Policy Ment Health

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This study sought to develop a typology of individuals with substance dependence (ISD) based on a longitudinal survey (n = 2,434) and 121 ISD. The latter were divided into three groups: newly abstinent individuals, chronic dependents and acute dependents. Individuals' typology was developed by cluster analysis. Newly abstinent individuals had fewer emotional problems and mental disorders in the previous 12 months. Four classes of ISD were identified, labelled respectively "chronic multi-substance consumption and mental disorders comorbidities," "multi-substance consumption," "alcohol and marijuana consumption" and "alcohol consumption only." Strategies adapted to each of these profiles could be promoted for more effective treatment.

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“…In previous studies, the rate of readmitted patients has proven to be 22% in America in psychiatric patients aged over 65 years [4], 19% of children admitted at the emergency ward in Baltimore were aged 4–18 [6], 14% of patients admitted at the psychological ward of the army in Washington [7], 33.7% of patients diagnosed with schizophrenia in Turkey [8], and 43% of teenage patients admitted for psychological reasons in Northern Carolina [3]. The readmission period has been defined controversially in different studies, for example, readmission in a period of 90 days [9], readmission in a period of 3 years [10], admission of three or more times in a period of 30 months [11], readmission in a period of 6 months [12], and admittance of 3 or more times in a period of 2.5 years [13]. This, in turn, resulted in different rates of readmission in different studies as 14% [7], 16% [12], 20–30% [10], and 45–53% [13].…”

Section: Introductionmentioning

confidence: 99%

“…The readmission period has been defined controversially in different studies, for example, readmission in a period of 90 days [9], readmission in a period of 3 years [10], admission of three or more times in a period of 30 months [11], readmission in a period of 6 months [12], and admittance of 3 or more times in a period of 2.5 years [13]. This, in turn, resulted in different rates of readmission in different studies as 14% [7], 16% [12], 20–30% [10], and 45–53% [13]. …”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Readmission of Patients at a University Hospital Psychiatric Ward in Iran

et al. 2013

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Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports.

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Subgroups of Frequent Users of an Inpatient Mental Health Program at a Community Hospital in Canada

Abstract: Identifying subgroups within the frequent-user population may help in developing appropriate treatment and discharge plans with the aim of reducing the need for frequent utilization of inpatient mental health services.

Cited by 30 publications

References 10 publications

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Typology of Individuals with Substance Dependence Based on a Montreal Longitudinal Catchment Area Study

Factors Associated with Readmission of Patients at a University Hospital Psychiatric Ward in Iran

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