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Articles   |    
Inpatient Psychiatric Care Experience and Its Relationship to Posthospitalization Treatment Participation
Nicholas W. Bowersox, Ph.D.; Amy S. B. Bohnert, Ph.D.; Dara Ganoczy, M.P.H.; Paul N. Pfeiffer, M.D., M.S.
Psychiatric Services 2013; doi: 10.1176/appi.ps.002342012
View Author and Article Information

The authors are affiliated with the Serious Mental Illness Treatment Resource and Evaluation Center, Health Services Research and Development Service, Department of Veterans Affairs Ann Arbor Healthcare System, North Campus Research Complex, Building 10, 2800 Plymouth Rd., Ann Arbor, MI 48109 (e-mail: nickbowe@med.umich.edu).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study used factor analysis of a Veterans Health Administration (VHA) survey to identify factors that measure satisfaction with inpatient treatment and to examine the factors’ utility in evaluating treatment participation following discharge.

Methods  The Survey of Healthcare Experiences of Patients (inpatient version) (I-SHEP) was mailed to 34,237 veterans who were discharged from inpatient to outpatient care in the VHA during fiscal year 2009 and was completed by 7,408 patients. A factor analysis of survey responses identified underlying I-SHEP factors and evaluated relationships between the factors, patient characteristics, and attendance at VHA mental health appointments within seven and 30 days of discharge.

Results  The factor analysis identified three domains of satisfaction: respect and caring by nurses–overall hospital impression; involvement and information about care; and respect and caring by doctors. These factors demonstrated good internal consistency (Cronbach’s α=.93, .90, and .94, respectively) and accounted for a moderate amount of variance in patient responses (r2=.167). Only the care involvement and information factor was associated with participation in follow-up care: increased satisfaction (one standard deviation change in scale score) was associated with improved odds of a mental health visit within seven and 30 days of discharge (odds ratio=1.14 and 1.17, respectively, p<.01).

Conclusions  After discharge, persons may not generalize satisfaction about the respect and caring shown by inpatient treatment teams toward their decision to attend outpatient care. Providing patients with information about treatment and involving them in care decisions during inpatient care may help facilitate the transition to outpatient settings.

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Table 1Characteristics of I-SHEP responders, I-SHEP nonresponders, and all patients who received VHA inpatient care in fiscal year 2009a
Table Footer Note

a VHA, Veterans Health Administration. The Survey of Healthcare Experiences of Patients (inpatient version) (I-SHEP) was mailed to 34,237 veterans who received VHA inpatient care in 2009 and were discharged to VHA outpatient care.

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b Statistical analyses reflect comparisons between I-SHEP responders and nonresponders only.

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c CCI, Charlson Comorbidity Index. Higher scores indicate increased medical comorbidity.

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Table 2Postrotation factor loadings for items on the Survey of Healthcare Experiences of Patients (inpatient version)a
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a The survey assesses various aspects of a hospital stay and was completed by 7,408 randomly selected veterans who received Veterans Health Administration inpatient care in 2009.

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Table 3Association between demographic and service use characteristics and I-SHEP factor scoresa
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a I-SHEP, Survey of Healthcare Experiences of Patients (inpatient version)

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b CCI, Charlson Comorbidity Index. Higher scores indicate increased medical comorbidity.

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*p<.05, **p<.01

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Table 4Relationships between increased satisfaction with inpatient care and patient characteristics and participation in outpatient mental health care at follow-upa
Table Footer Note

a All predictor variables were included in simultaneous-entry logistic regression models designed to predict the outcome measures.

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b Inpatient care was measured by three factors derived from the Survey of Healthcare Experiences of Patients (inpatient version) (I-SHEP). Increased satisfaction was indicated by one standard deviation change in scores for each I-SHEP factor scale.

Table Footer Note

c CCI, Charlson Comorbidity Index. Higher scores indicate increased medical comorbidity.

Table Footer Note

*p<.05, **p<.01

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