(Mar. 14, 2017) Hospital ownership matters when it comes to the quality of psychiatric inpatient care, according to the first published analysis of the relationship.
In a study published in Psychiatric Services, Morgan C. Shields and Meredith B. Rosenthal analyzed the reports of 665 accredited inpatient psychiatric facilities to the Inpatient Psychiatric Facility Quality Reporting Program (IPFQR) under the Affordable Care Act.
"Hospital ownership strongly predicted performance, and (Veterans Administration) hospitals performed relatively poorly across most measures," the researchers found.
Seven Core Qualities
Under IPFQR, psychiatric facilities that fail to report to the Centers for Medicare and Medicaid Services on outcomes from seven core quality measures are penalized in 2% annual payment reductions. The seven core qualities involve practices around admission screening; seclusion; restraint; discharge of patients on multiple antipsychotics; appropriate justification for discharge on multiple antipsychotics; continuing-care plans for discharge; and transmission of treatment plans to the next level of care upon discharge.
Overall, hospitals did the best on admission screening and the worst on appropriately justifying hospital discharge on multiple antipsychotics.
Public reporting of hospital quality for non-psychiatric services has become common in the United States. For example, it is possible to compare the death and adverse outcome rates of individual hospitals for low-risk surgery, high-risk surgery, complicated and uncomplicated baby delivery and a host of other hospital procedures. The authors described similar measurement and reporting of inpatient psychiatric quality of care as "at a nascent stage."
"Until now, the quality of inpatient psychiatric care has not been similarly subjected to public scrutiny," they said. "The national climate regarding mental health care reform, which has focused on expanding access to care, necessitates a thorough understanding of the quality of available services."
Comparative Performance
The authors' resulting analysis compared hospitals in four categories of ownership: Veterans Administration (VA), other government, nonprofit and for-profit. Their findings included:
- For-profit hospitals performed the best in terms of admission screening, limiting the use of restraint and seclusion, creating a continuing-care plan at discharge and transmitting the care plan to the next level at discharge.
- Nonprofit hospitals performed the best in terms of limiting prescription of multiple antipsychotics at discharge.
- Non-VA government hospitals (e.g., state and county hospitals) performed the best in terms of having an appropriate justification for antipsychotic prescription at the time of hospital discharge.
- VA hospitals were inferior by every measure and the worst performers for admission screening, use of seclusion, creating a continuing-care plan and transmitting the care plan.
Inappropriate to Label
Despite the statistical results of comparison, the authors said it would be "inappropriate to simply label certain facilities as 'high quality' or 'low quality'" on the basis of the measures. While hospital ownership clearly matters, and VA hospitals consistently underperform all others, they said, the context necessary for meaningful comparison of quality is largely missing.
For example, unreported differences in resources, staff training and/or case mix could affect the performances of different hospital ownership models, they said. The poor performance of VA hospitals might be partly explained by lack of funding. Lower rates of admission screening could be explained by hospitals admitting higher numbers of severely ill patients who cannot communicate well enough to be screened.
"Even the best hospitals showed some room for improvement," the authors concluded.
The number of core measures reported to the IPFQR program is scheduled to expand to 16 this year. One of the additional measures of quality will be 30-day rehospitalization rates, which the Treatment Advocacy Center analyzed in its 2016 study Released, relapsed, rehospitalized.
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Shields, M.C. and M.B. Rosenthal. (March 2017). Quality of inpatient psychiatric care at VA, other government, nonprofit and for-profit hospitals: A comparison. Psychiatric Services.
- Fuller, D.A. et al. (November 2016). Released, relapsed, rehospitalized: Length of stay and readmission rates in state hospitals, a comparative state survey. (Treatment Advocacy Center).
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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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