The Role of Race in Admission to a Dual Diagnosis Unit Versus General Inpatient Psychiatric Unit in those with Active Substance Use

Psychiatric disorders are highly comorbid with substance use disorders, and the presence of co-occurring conditions increases severity of illness and complicates recovery. Those with comorbid mental illness and substance use disorders may benefit from specialized services, specifically integrated dual diagnosis treatment. Admission to a dual diagnosis unit requires health care providers to consider a number of factors, including severity of illness, psychiatric history, bed availability, and providers’ perceived likelihood of benefit of specialized services. Ideally, decisions regarding the necessity of substance use treatment are made independent of race, and yet, racial disparities exist among those who are offered substance use treatment. The aim of this study was to evaluate the demographic differences of patients who are identified as having active substance use admitted from the comprehensive psychiatric emergency program (CPEP) to a dual diagnosis unit versus those admitted to a general inpatient psychiatric unit. Our study consists of a retrospective analysis of patients, aged 18–90 (n = 100), admitted to either a dual diagnosis unit (8B) or general psychiatric unit (6K) at Mount Sinai Beth Israel (MSBI), a private metropolitan hospital in New York City, between November 1st to November 30th, 2020. We hypothesized that there are racial disparities in unit assignments while accounting for a variety of potentially relevant demographic and clinical variables. The primary outcome was a comparison of demographic factors, particularly racial composition, of those admitted to the dual diagnosis unit versus those admitted to the general psychiatric unit. After accounting for 6 clinical and 3 other demographic variables, patients of Black race were over 5 times more likely (adjusted odds ratio 5.31; P = 0.011) to be assigned to 8B than patients of White, Asian, or Other race. Additional contributors to 8B assignment were male gender, IM or IV PRNs, and documented substance use ('Table 1'). There were no significant differences between Black and Non-Black patients in rates of substance use detected on toxicology ('Table 2'). These findings suggest that race may be a driving factor in unit assignment, and unconscious racial bias may potentially confound admission decision-making, limiting access to available resources and services for some populations. More research is needed to understand factors contributing to racial disparities in substance use treatment

The Patient Experience Debrief Interview: How Conversations With Hospitalized Families Influence Medical Student Learning and Reflection

PURPOSE: To determine the effect of patient debrief interviews on pediatric clerkship student depth of reflection and learning. METHOD: The authors conducted a multi-institutional, mixed-methods, cluster randomized trial among pediatric clerkship students from May 2016 to February 2017. Intervention students completed a debrief interview with a patient-caregiver, followed by a written reflection on the experience. Control students completed a written reflection on a memorable patient encounter. Three blinded authors scored written reflections according to the 4-level REFLECT rubric to determine depth of reflection. Interrater reliability was examined using kappa. REFLECT scores were analyzed using a chi-square test; essays were analyzed using content analysis. RESULTS: Eighty percent of eligible students participated. One hundred eighty-nine essays (89 control, 100 intervention) were scored. Thirty-seven percent of the control group attained reflection and critical reflection, the 2 highest levels of reflection, compared with 71% of the intervention group; 2% of the control group attained critical reflection, the highest level, compared with 31% of the intervention group (χ(3, N = 189) = 33.9, P \u3c .001). Seven themes were seen across both groups, 3 focused on physician practice and 4 focused on patients. Patient-centered themes were more common in the intervention group, whereas physician-focused themes were more common in the control group. CONCLUSIONS: Patient debrief interviews offer a unique approach to deepen self-reflection through direct dialogue and exploration of patient-caregiver experiences during hospitalization