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Classifying psychiatric inpatients: seeking better measures.

https://arctichealth.org/en/permalink/ahliterature202354
Source
Med Care. 1999 Apr;37(4):415-23
Publication Type
Article
Date
Apr-1999
Author
J. Durbin
P. Goering
G. Pink
M. Murray
Author Affiliation
Health Systems Research Unit, Clarke Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. jdurbin@hsru.clarke-inst.on.ca
Source
Med Care. 1999 Apr;37(4):415-23
Date
Apr-1999
Language
English
Publication Type
Article
Keywords
Comorbidity
Diagnosis-Related Groups - classification - statistics & numerical data
Hospitals, Psychiatric - utilization
Humans
Inpatients - classification
Length of Stay
Medical Records
Mental Disorders - classification
Ontario
Psychiatric Department, Hospital - utilization
Regression Analysis
Retrospective Studies
Severity of Illness Index
Abstract
Use of case-mix reimbursement in psychiatric inpatients has been limited as a result of a lack of systems which effectively group patients according to required resource needs. In recognition of the fact that many patient factors, in addition to diagnosis influence delivery of care in psychiatry, new measures of patient need are emerging.
This study compared improvement realized by using a multidimensional measure of patient severity, the Computerized Severity Index (CSI), to predict length of stay (LOS) in psychiatric inpatients over that achieved by using patient variables routinely collected in the discharge abstract.
Through retrospective chart review, severity ratings were made on 355 psychiatric discharges with primary diagnoses of psychotic or major depressive disorders. Those ratings were combined with demographic and diagnostic data available in discharge abstracts and were then entered into multivariate regression analyses to model LOS.
CSI ratings significantly contributed to prediction models, which accounted for an additional 9% to 11% of variation in LOS over discharge abstract data. Among patients with psychotic disorders, maximum severity during hospitalization was the best predictor of LOS, whereas among patients with depressive disorders, it was an increase in severity following admission.
Severity ratings, based on chart review, improved prediction of LOS over discharge abstract variables for psychiatric inpatients in two diagnostic groups. Further research is needed to estimate the impact of incorporating severity ratings into a grouping system for all psychiatric inpatients. Estimation of predictive accuracy is important to determine the amount of risk passed on to providers in a payment system based on psychiatric case mix.
PubMed ID
10213022 View in PubMed
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A comparison of outpatients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitals.

https://arctichealth.org/en/permalink/ahliterature141858
Source
J Intellect Disabil Res. 2011 Feb;55(2):242-7
Publication Type
Article
Date
Feb-2011
Author
Y. Lunsky
C. Gracey
E. Bradley
C. Koegl
J. Durbin
Author Affiliation
Centre for Addiction and Mental Health, Dual Diagnosis, Toronto, Ontario, Canada. yona_lunsky@camh.net
Source
J Intellect Disabil Res. 2011 Feb;55(2):242-7
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Health Services Needs and Demand - statistics & numerical data
Hospitals, Psychiatric - utilization
Humans
Intellectual Disability - therapy
Mental Health Services - utilization
Mentally Disabled Persons - statistics & numerical data
Ontario
Outpatients - statistics & numerical data
Patient Acceptance of Health Care - statistics & numerical data
Socioeconomic Factors
Abstract
This study compares outpatients with intellectual disability (ID) receiving specialised services to outpatients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources, and clinical service needs.
A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for a stratified random sample of 246 outpatients identified as having ID, from both specialised and general programmes.
Individuals with ID in specialised programmes differed from patients with ID in general programmes with regard to demographics, diagnostic profile, symptom presentation and recommended level of care.
Further research is required to determine why individuals access some services over others and to evaluate whether specialised services are more appropriate for certain subgroups with ID than others.
PubMed ID
20666932 View in PubMed
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A comparison of patients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitals.

https://arctichealth.org/en/permalink/ahliterature158269
Source
J Intellect Disabil Res. 2008 Nov;52(11):1003-12
Publication Type
Article
Date
Nov-2008
Author
Y. Lunsky
E. Bradley
J. Durbin
C. Koegl
Author Affiliation
Centre for Addiction and Mental Health, Toronto, Ontario, Canada. yona_lunsky@camh.net
Source
J Intellect Disabil Res. 2008 Nov;52(11):1003-12
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Adult
Cross-Sectional Studies
Female
Health Services Needs and Demand - statistics & numerical data
Hospitals, Psychiatric - utilization
Humans
Inpatients - psychology - statistics & numerical data
Intellectual Disability - epidemiology - psychology
Male
Mental Disorders - epidemiology - psychology - therapy
Mental Health Services - utilization
Middle Aged
Ontario - epidemiology
Abstract
Over the years, the closure of institutions has meant that individuals with intellectual disabilities (IDs) must access mainstream (i.e. general) mental health services. However, concern that general services may not adequately meet the needs of patients with ID and mental illness has led to the development and implementation of more specialised programmes. This study compares patients with ID receiving specialised services to patients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources and clinical service needs.
A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for all 371 inpatients with ID, from both specialised and general programmes.
Inpatients in specialised programmes were more likely to have a diagnosis of mood disorder and were less likely to have a substance abuse or psychotic disorder. Individuals receiving specialised services had higher ratings of challenging behaviour than those in more general programmes. The two groups did not differ significantly in terms of recommended level of care, although more inpatients from specialised programmes were rated as requiring Level 4 care than inpatients from general programmes.
In Ontario, inpatients in specialised and general programmes have similar overall levels of need but unique clinical profiles that should be taken into consideration when designing interventions for them.
PubMed ID
18341526 View in PubMed
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Housing homeless women: a consumer preference study.

https://arctichealth.org/en/permalink/ahliterature228748
Source
Hosp Community Psychiatry. 1990 Jul;41(7):790-4
Publication Type
Article
Date
Jul-1990
Author
P. Goering
D. Paduchak
J. Durbin
Author Affiliation
Social and Community Psychiatry Section, Clarke Institute of Psychiatry, Toronto, Canada.
Source
Hosp Community Psychiatry. 1990 Jul;41(7):790-4
Date
Jul-1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude
Female
Health status
Homeless Persons - psychology
Housing
Humans
Mental Disorders - psychology
Middle Aged
Ontario
Questionnaires
Single Person - psychology
Socioeconomic Factors
Urban Population
Abstract
Consumer preference surveys can provide valuable information on which to base the planning and development of housing for groups with special needs. The authors describe a survey that explored the housing histories, problems, needs, and preferences of a sample of 38 chronically homeless women contacted in metropolitan Toronto hostels and drop-in centers. Despite having multiple mental and physical health problems, the women showed a strong preference for a normal, independent living situation. However, they acknowledged the need for a range of supportive services to maintain themselves in such a situation. The women strongly opposed being housed in settings with mentally ill persons, with alcohol or drug abusers, and with those involved in criminal activities.
PubMed ID
2365314 View in PubMed
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Needs-based planning: evaluation of a level-of-care planning model.

https://arctichealth.org/en/permalink/ahliterature194865
Source
J Behav Health Serv Res. 2001 Feb;28(1):67-80
Publication Type
Article
Date
Feb-2001
Author
J. Durbin
J. Cochrane
P. Goering
D. Macfarlane
Author Affiliation
Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Health Systems Research and Consulting Unit, 250 College Street, 4th floor, Toronto, Ontario, Canada M5T 1R8. Janet_Durbin@camh.net
Source
J Behav Health Serv Res. 2001 Feb;28(1):67-80
Date
Feb-2001
Language
English
Publication Type
Article
Keywords
Aged
Community Mental Health Centers
Deinstitutionalization
Female
Health Facility Closure - methods
Health Planning - methods
Hospitals, Psychiatric - organization & administration
Humans
Inpatients
Male
Models, Nursing
Needs Assessment
Ontario
Patient Transfer - statistics & numerical data
Residential Facilities
Abstract
With the closure of a number of provincial psychiatric hospitals planned, the Ministry of Health of Ontario has commissioned a series of planning projects to identify alternative placements for current hospital patients. The goal is to match need to care in the least restrictive setting. A systematic, clinically driven planning process was implemented that involved three steps: development of a continuum of levels of care representing increasingly intensive and more restrictive supports, development of criteria and decision rules for placement, and comprehensive needs assessment of current patients using the Colorado Client Assessment Record. Results showed that only 10% of current inpatients need to remain in the hospital, and over 60% could live independently in the community with appropriate supports. Evidence supports concurrent validity of the planning model, but further work is needed to assess whether recommended levels of care effectively meet consumer needs in the least restrictive setting.
PubMed ID
11330000 View in PubMed
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Tertiary mental health services: II. Subpopulations and best practices for service delivery.

https://arctichealth.org/en/permalink/ahliterature199026
Source
Can J Psychiatry. 2000 Mar;45(2):185-90
Publication Type
Article
Date
Mar-2000
Author
J. Cochrane
P. Goering
J. Durbin
D. Butterill
J. Dumas
D. Wasylenki
Author Affiliation
Centre for Addiction & Mental Health, Clarke Division, Toronto, Ontario.
Source
Can J Psychiatry. 2000 Mar;45(2):185-90
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Brain Injuries - psychology
Community Mental Health Services - organization & administration
Diagnosis, Dual (Psychiatry)
Humans
Mental Disorders - etiology - therapy
Ontario
Abstract
Tertiary care subpopulations are characterized by having more than one significant condition, each of which has been traditionally dealt with by different systems of care. They experience severe and persistent mental illness and one or more of the following: age-related physical or medical conditions, substance use disorders, developmental handicaps, and acquired brain injury. This paper provides estimates of prevalence for each of these subgroups and discusses best practices which have developed in response to their special needs.
Notes
Comment In: Can J Psychiatry. 2000 Aug;45(6):57010986576
PubMed ID
10742879 View in PubMed
Less detail

Tertiary mental health services: I. Key concepts.

https://arctichealth.org/en/permalink/ahliterature199027
Source
Can J Psychiatry. 2000 Mar;45(2):179-84
Publication Type
Article
Date
Mar-2000
Author
D. Wasylenki
P. Goering
J. Cochrane
J. Durbin
J. Rogers
P. Prendergast
Author Affiliation
St Michael's Hospital, Toronto. On. donald.wasylenki@utoronto.ca
Source
Can J Psychiatry. 2000 Mar;45(2):179-84
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Community Mental Health Services - organization & administration
Humans
Ontario
Residential Treatment
Abstract
There are some individuals with severe and persistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospital-based services. Increasingly, organized systems have been developed to ensure that individuals meet criteria for tertiary care and receive the most appropriate level of care. Most importantly, the delivery of tertiary care must not be tied to particular settings or time frames, and level of care must be delinked from model or location of care in order to create flexible, efficient, effective mental health services.
PubMed ID
10742878 View in PubMed
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8 records – page 1 of 1.