Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures

Abstract

Following discharge from inpatient psychiatry, patients experience elevated suicide risk, unplanned readmission, and lack of outpatient follow-up visits. These negative outcomes might relate to patient-centered care (PCC) experiences while hospitalized. We surveyed 739 former patients of inpatient psychiatric settings to understand the relationship between PCC and changes in patients' trust, willingness to engage in care, and self-reported 30-day follow-up visits. We also linked PCC measures to facility-level quality measures in the Inpatient Psychiatric Facility Quality Reporting program. Relative to patients discharged from facilities in the top quartile of PCC, those discharged from facilities in the bottom quartile were more likely to experience reduced trust (predicted probability [PP] = 0.77 vs 0.46; P < .001), reduced willingness to go to the hospital voluntarily (PP = 0.99 vs 0.01; P < .001), and a lower likelihood of a 30-day follow-up (PP = 0.71 vs 0.92; P < .001). PCC was lower among patients discharged from for-profits, was positively associated with facility-level quality measures of 7- and 30-day follow-up and medication continuation, and was inversely associated with restraint use. Findings underscore the need to introduce systematic measurement and improvement of PCC in this setting.

Keywords: mental health care; patient experience; policy; public reporting; quality.

Figure 1.

Box plots of predicted probabilities from adjusted regression models of PCC on negative patient-reported outcomes. Source: Data are from an online survey administered to former inpatient psychiatry patients in 2021. Predicted probabilities come from 4 regression models (n = 739). Full models are provided in the Supplemental Material Table S2. Box plots represent the interquartile range in the colored box, with the median at the point of the line; the tails indicate the maximum and minimum probabilities. ****P < .001. Abbreviations: PCC, patient-centered care; Ref, reference group.

Figure 2.

Box plots of predicted probabilities from adjusted regression models of PCC on positive patient-reported outcomes. Source: Data are from an online survey administered to former inpatient psychiatry patients in 2021. Predicted probabilities come from 5 regression models (n = 739). Full models are provided in the Supplemental Material Table S3. **P < .05; ****P < .001. Box plots represent the interquartile range in the colored box, with the median at the point of the line; the tails indicate the maximum and minimum probabilities. Abbreviations: PCC, patient-centered care; Ref, reference group.