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Case mix in the "downsizing" state hospital

1996; American Psychiatric Association; Volume: 47; Issue: 3 Linguagem: Inglês

10.1176/ps.47.3.255

1557-9700

William H. Fisher, L. Šimon, Josie Geller, Walter E. Penk, Elizabeth Irvin, C L White,

Primary Care and Health Outcomes

Back to table of contents Previous article Next article No AccessCase mix in the "downsizing" state hospitalPublished Online:1 Apr 2006https://doi.org/10.1176/ps.47.3.255AboutSectionsView articleAbstractPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstractOBJECTIVE: The study examined whether local variations in levels of community-based services affect the case mix of state hospitals undergoing census reduction. METHODS: Trends in case mix over a 14-year period were analyzed at two Massachusetts state hospitals, one of which underwent more rapid census reduction due to expanded community resources in the catchment area it served. Data on patients' hospital use and on sociodemographic and diagnostic characteristics obtained from 1977, 1986, and 1991 assessments of the hospitals' populations were compared. These time points represented the beginning, midpoint, and end of the census reduction period. Data from 1991 on patients' behavioral and functional status were also examined. RESULTS: Parallel trends on many dimensions were evident at the two hospitals as their censuses fell. By 1986 the hospital operating in the area with greater community services had fewer elderly and long-stay patients but a higher number of admissions per patient. In 1991 this hospital's population also had more patients with high-risk violent behaviors and lower levels of functioning. CONCLUSIONS: Although alternative treatment settings allow diversion of many types of patients from state hospitals, expanded community-based services and alternative inpatient beds have not diverted some patient subgroups, including recidivists and patients with behaviors that present risks in other settings. Plans for meeting the clinical needs and behavioral challenges posed by such patients must be part of any further deinstitutionalization or privatization efforts. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byExpert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data24 December 2021 | Frontiers in Psychiatry, Vol. 12International Journal of Law and Psychiatry, Vol. 29, No. 6One-Year Follow-Up of Persons Discharged From a Locked Intermediate Care FacilityH. Richard Lamb, M.D., and Linda E. Weinberger, Ph.D.1 February 2005 | Psychiatric Services, Vol. 56, No. 2Long-Stay Patients in State Psychiatric Hospitals at the End of the 20th CenturyWilliam H. Fisher, Ph.D., Paul J. Barreira, M.D., Jeffrey L. Geller, M.D., M.P.H., Andrew W. White, M.A., Alisa K. Lincoln, Ph.D., and Marylou Sudders, M.S.W.1 August 2001 | Psychiatric Services, Vol. 52, No. 8New Directions for Mental Health Services, Vol. 2001, No. 91Assaults on Staff by Psychiatric Patients in Community ResidencesRaymond B. FlanneryJr., Ph.D., William Fisher, Ph.D., Andrew Walker, Karolina Kolodziej, and Michael J. Spillane1 January 2000 | Psychiatric Services, Vol. 51, No. 1The Last Half-Century of Psychiatric Services as Reflected in Psychiatric ServicesJeffrey L. Geller, M.D., M.P.H.1 January 2000 | Psychiatric Services, Vol. 51, No. 1International Journal of Law and Psychiatry, Vol. 23, No. 3-4Schizophrenia Research, Vol. 43, No. 1Symptoms, Cognitive Functioning, and Adaptive Skills in Geriatric Patients With Lifelong Schizophrenia: A Comparison Across Treatment SitesPhilip D. Harvey, Ph.D., Evelyn Howanitz, M.D., Michael Parrella, Ph.D., Leonard White, Ph.D., Michael Davidson, M.D., Richard C. Mohs, Ph.D., Jennifer Hoblyn, M.D., and Kenneth L. Davis, M.D.1 August 1998 | American Journal of Psychiatry, Vol. 155, No. 8American Journal of Medical Quality, Vol. 13, No. 3 Volume 47Issue 3 March 1996Pages 255-262 Metrics PDF download History Published online 1 April 2006 Published in print 1 March 1996