Monday, June 29, 2009

Study Shows Multifaceted Inpatient Psychiatry Approach Can Reduce Readmissions

According to a new study conducted by staff at Mayo Clinic and Austin Medical Center — part of Mayo Health System, patients treated at a rural hospital utilizing a multifaceted inpatient psychiatry approach (MIPA) had lower odds of readmission within 30 days.

Access to psychiatric services in rural areas, particularly inpatient psychiatric care, is limited and care may not be as comprehensive as in metropolitan areas. The purpose of the study, published in the Summer 2009 issue of The Journal of Rural Health, evaluated the impact of the MIPA approach to psychiatric inpatient care on readmission rates in a rural hospital setting.

"The primary treatments for patients who enter inpatient psychiatric hospitals include medication management, group psychotherapy and brief inpatient hospital stays. However, research has shown that this standard of care can result in high numbers of readmissions within 30 days," according to Timothy Lang, Psy.D., a clinical psychologist at Austin Medical Center and one of the study's authors. "To the extent that readmissions may be avoidable, they can be characterized as overutilization of services which can place a strain on both inpatient facility staff and the patient. Approaches like MIPA need to be explored as a practice innovation for inpatient psychiatric facilities."

The MIPA model of inpatient psychiatric care emphasizes a comprehensive diagnosis of the patient's condition with that diagnosis driving treatment and more effective interventions. Austin Medical Center incorporated many of the MIPA best practices that had been reported in the literature, including targeted psychopharmacology; psychological and cognitive testing; occupational therapy; chemical dependency evaluations, smoking cessation group therapy; dietary group therapy; family meetings; contacts with friends and/or family to provide input for improving diagnosis reliability; and relapse prevention.

The study utilized data on psychiatric inpatient readmissions data gathered from 1999 to 2005 at Austin Medical Center. The study's authors compared readmissions within 30 days for patients who were admitted to an inpatient psychiatric unit using a MIPA model of care to readmissions of a comparison group of patients admitted prior to Austin Medical Center's adoption of MIPA in July 2002.

The findings showed that prior to Austin Medical Center's implementation of MIPA, 12 of 37 patients, or 32.4 percent, were readmitted within 30 days. In contrast only seven of 147 patients, or 4.8 percent, were readmitted following MIPA implementation. In addition, significant increases in the percentage of patients' utilization of services following MIPA implementation were noted. These services include psychological testing; occupational therapy; chemical dependency evaluations; smoking cessation counseling; dietary counseling; family meetings; collateral contacts; relapse prevention and follow-up outpatient visits. While specific services that may have caused a reduction in readmission rates cannot be determined from this study, services are regarded as a bundle that is believed to have a collective impact.

"This study indicates the impact of MIPA is positive for patients," according to another study author, James Rohrer, Ph.D., Mayo Clinic Department of Family Medicine. "The results support cautious optimism that the MIPA of inpatient psychiatric care has reduced readmission rates. The implementation of this model in a rural hospital demonstrates that access to high-quality inpatient psychiatric care is achievable in rural settings."

Another study author is Pierre Rioux, M.D., medical director of Austin Medical Center's psychiatric inpatient unit and an instructor in psychiatry at Mayo Clinic.
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