Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment

Abstract Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence. Conclusions The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.http://deepblue.lib.umich.edu/bitstream/2027.42/112590/1/12913_2012_Article_2419.pd

Prenatal patterned auditory stimulation and its effect on post-hatch preference behavior and activity of the neonatal Domestic Chicken (Gallus gallus domesticus).

This thesis has no abstract

Predicting Recidivism in Sex Offenders Using the SVR-20: The Contribution of Age-at-release

Sex offenders (N = 468) were released from custody and recidivism outcome was recorded. The Sexual Violence Risk-20 (SVR-20) was scored for each offender and the relationship between age-at-release and SVR-20 item and total scores was examined. SVR-20 total scores were not correlated with age-at-release (r = .-057). SVR-20 scores were combined with a score representing the age of the offender at their release from custody. On the basis of ROC analysis, predictive accuracy was significantly enhanced when age-atrelease was included in the risk score. We suggest that the SVR-20, and perhaps other similar risk instruments, could be improved by including age-at-release information. We discuss the possibility that the advantage obtained by empirical actuarial instruments may be due in part to their close relation with age-at-release

Denial and minimization among sexual offenders: Posttreatment presentation and association with sexu

The relationship between sexual recidivism and posttreatment denial and minimization was examined among 436 sex offenders followed up for an average period of more than 5 years. Treatment completion status and psychopathic traits, both established predictors of sexual recidivism also associated with denial and minimization, were included in survival analyses to remove their confounding influence on the focal relationships. The potential role of actuarial risk as a moderating variable was also investigated. A dichotomous variable reflecting denial and minimization failed to predict sexual recidivism. However, among a subset of 102 sex offenders who received no additional treatment after completing an initial program, the interaction between actuarial risk and scores on a continuous measure of minimization predicted sexual recidivism. Implications for assessment, particularly the need to move beyond dichotomous operationalizations of denial and minimization, and treatment were discussed

Predictors of progression from high to medium secure services for personality-disordered patients

A significant number of inpatients in English high secure hospitals are detained under the Mental Health Act of 2007 with a diagnosis of personality disorder. The main route of discharge for these patients is via mediumsecurity units. This study sought to determine if male personality-disordered patients’ ability to progress from high to medium secure services is associated with a level of violent risk (Historical, Clinical, Risk Management 20), clinical psychopathy (Psychopathy Checklist-Revised (PCL-R)) and evidence of specifi c personality disorder diagnoses (assessed using the Personality Diagnostic Questionnaire-4th edition plus (PDQ-4) and Personality Assessment Inventory (PAI)). Sixty-fi ve male inpatients within an English high secure personality disorder service who had been assessed using the relevant instruments in 2001 were followed up six years post-assessment to determine if they had progressed to a medium secure service. The results revealed that the antisocial scales of the PAI and PDQ-4, the PCL-R (particularly factor 1) and the PAI-Paranoid scale were reliable inverse predictors of institutional progression. The fi ndings from this study suggested that the needs of more severely antisocial and psychopathic, individuals might require greater consideration within forensic psychiatric services