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Brief Reports   |    
Interprofessional Differences in Disposition Decisions: Results From a Standardized Web-Based Patient Assessment
Tristan Gorrindo, M.D.; Elizabeth Goldfarb, B.A.; Lydia Chevalier, B.S.; Bettina B. Hoeppner, Ph.D., M.S.; Robert J. Birnbaum, M.D., Ph.D.; Benjamin Meller, B.S.; Jonathan E. Alpert, M.D., Ph.D.; John Herman, M.D.; Anthony P. Weiss, M.D., M.B.A.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200461
View Author and Article Information

With the exception of Dr. Hoeppner, all authors are affiliated with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Hoeppner is with the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. Send correspondence to Dr. Gorrindo, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 700, Boston, MA 02114 (e-mail: tristan.gorrindo@mgh.harvard.edu).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study examined differences in disposition decisions among mental health professionals using a standardized Web-based simulation.

Methods  Using a Web-based simulation that described, across users, the same complex psychiatric patient, credentialed clinicians in a psychiatry department conducted a violence risk assessment and selected a level of follow-up care.

Results  Of 410 clinicians who completed the simulation, 60% of psychiatrists were more likely than other types of clinicians to select higher levels of care (inpatient or emergency services) for the standardized virtual patient (odds ratio=2.67, 95% confidence interval=1.67–4.25), even after adjustment for other factors. Virtual actions taken, such as contracting with the patient for safety and discussing hospitalization, elucidated these training differences.

Conclusions  Training backgrounds were important determinants of clinicians’ actions and the dispositions they recommended for a psychiatric patient at high risk of self-harm and harm to others in the educational setting and may suggest the need for further training to standardize and optimize care.

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Anchor for Jump
Table 1Predictors of inpatient level-of-care disposition decision among 358 mental health clinicians evaluating the same Web-based patient simulation
Table Footer Note

a CSAT, computer simulation assessment tool

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