A Move to Judge Psychiatric Hospitals

empirical measures/gaps in treatment

I couldn't agree more that we need meaningful ways to measure the effectiveness of psychiatric hospitals and mental health programs. As other readers have noted, producing numbers for the sake of bean counting provides no information at all. Why DO we collect these numbers? Hopefully to improve patient care and patient outcomes. Isn't this what everybody wants - patients, hospitals, insurance companies, oversight agencies, etc?

I write as a mental healthcare consumer on the eve of entering a psychiatric hospital for the 2nd time in less than two years. Most of the programs out there are cookie cutter in the sense that it's group therapy for the masses and not nearly tailored enough to each individual. The one program that would be best suited for my condition has a waiting list of 2 weeks. Admittedly I'm now speaking to different (though related) issues that are frustrations of dealing with the mental health system and the gaps in care. In any case, finding more meaningful ways to collect data for programmatic quality assessment and patient outcomes purposes go hand in hand. Maybe while I'm in the hospital I'll take along the commission report that was referenced in the article...I'm gonna have some time on my hands.

mental health treatment

". . . and—probably more telling—the percentage of patients discharged on multiple medications with adequate justification. . . ."

Pharmaceutical medications are the backbone of psychiatric treatment; without them, practitioners would have to institutionalize the patients instead of permitting them freedom to live in the community. Unfortunately, many people with mental problems fail to get good treatment, perhaps because of the reasons pointed out in the article. In our community, it seems like just about every week or so, a person with mental problems has to be "taken out" by a police SWAT team, which apparently has been determined to be cheaper than providing high-quality psychiatric treatment to all, regardless of ability to pay.

Psychiatric units and hospitals

Here's an idea: patient satisfaction surveys mailed out or telephoned 6 months after discharge. After 6 months, shame and stockholm syndrome have usually worn off and you would get honest responses. Since psychiatry is subjective, why not subjective responses from its patients as a measure of effectiveness?

Also look at actual treatment provided other than "milieu" code for just being there and drugs. Most psychiatric hospitals no longer have much other than desultory groups run by underqualified mental health workers. How about psychotherapy in the hospital and referrals to psychotherapy on discharge also? It is not all about the meds and recovery will not happen from medication alone. http://hymes.wordpress.com

On Reputation Alone

Where we would look for empirical support for the quality of care at any hospital, why does US New & World Report do less for psychiatric hospitals? As was noted above, US News & World Report relied exclusively on reputation as its sole criterion.

The nature, timing, extent, and modalities used along with the outcomes achieved at both discharge and longer were ignored. It is not surprising that too many patients find that being in a psychiatric hospital means little more than "meds, beds, and milieu" with a few desultory groups tossed in. A far cry from the evidence based, comprehensive, recovery oriented, person centered care so frequently represented but rarely delivered.

In a world where words and deeds can fail to intersect, one would have thought that US News & World Report would have looked beyond reputations. Where we prize the professional skepticism of journalists none was evidenced in US News & World Report's rankings of psychiatric hospitals. Here words alone were considered good enough.

Outcomes at the OCD Institute, McLean Hospital / Massachusetts General Hospital at McLean:

http://www.mclean.harvard.edu/ppt/patient/adult/ocd-outcome.ppt

Quality of Psychiatric Care

There are far more measures than those suggested by the Joint Commission.

How about:

Successful Discharge Rate - % of patients discharge who do not require re-hospitalization within a pre-determined period (say 30 days).

Continuity of care Success Rate - % of discharged patients still in the community and active treatment after 90 days.

Restraint rate/First time admissions - Restraint Hours per 1000 patient hours in first time admissions

Restraint rate/2nd - 4th admissions

SPMI restraint rate - Restraint rate among patients with 5 or more admissions

Weaknesses in JC strategy

Physical restraint rate does not get weighted relative to the acuity of the patients served. Those who serve the "worried well" with insurance will have outstanding numbers. As with all areas of medicine, those taking the most challenging cases will have the higher rates.

Similarly multiple medication strategies will be far more common among those who take the hardest cases with a lifetime of treatment refractory