PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of hsresearchLink to Publisher's site
 
Health Serv Res. 1993 June; 28(2): 131–158.
PMCID: PMC1069927

Measuring quality of care in psychiatric emergencies: construction and evaluation of a Bayesian index.

Abstract

OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary data collected over a 12-month period from two urban hospitals in the Northeast. One had 700 inpatient beds, an inpatient psychiatric unit, and community mental health personnel located in the emergency department. The other had 300 beds but none of the other hospital's features. STUDY DESIGN. The index was developed by a panel of experts in emergency psychiatry using a subjective Bayesian statistical methodology and was evaluated in terms of its ability to: (1) predict a second panel's judgments of quality; (2) predict a specific quality-related patient outcome, i.e., compliance with follow-up recommendations; (3) provide a reliable measurement procedure; and (4) detect variations in patterns of emergency department practices. DATA COLLECTION/EXTRACTION METHODS. Data were collected on 2,231 randomly selected emergency psychiatric patients (psychiatric diagnosis, alcohol abuse, nonverbal patients experiencing a psychiatric emergency, and patients with somatic complaints such as life crisis) treated in the emergency departments of the two hospitals. PRINCIPAL FINDINGS. The index predicted physician judgments of quality, was reliable, exhibited sufficient variation in scores, and was strongly associated with patient compliance. CONCLUSIONS. The study demonstrated that a subjective Bayesian model can be used to develop a reliable and valid index for measuring quality of care, with potential for practical application in management of health services.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • ADAMS JK, ADAMS PA. Realism of confidence judgments. Psychol Rev. 1961 Jan;68:33–45. [PubMed]
  • Gerson S, Bassuk E. Psychiatric emergencies: an overview. Am J Psychiatry. 1980 Jan;137(1):1–11. [PubMed]
  • Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989 Jan 5;320(1):53–56. [PubMed]
  • Gustafson DH, Fryback DG, Rose JH, Prokop CT, Detmer DE, Rossmeissl JC, Taylor CM, Alemi F, Carnazzo AJ. An evaluation of multiple trauma severity indices created by different index development strategies. Med Care. 1983 Jul;21(7):674–691. [PubMed]
  • Gustafson DH, Sainfort FC, Van Konigsveld R, Zimmerman DR. The Quality Assessment Index (QAI) for measuring nursing home quality. Health Serv Res. 1990 Apr;25(1 Pt 1):97–127. [PMC free article] [PubMed]
  • Jacobs D. Evaluation and care of suicidal behavior in emergency settings. Int J Psychiatry Med. 1982;12(4):295–310. [PubMed]
  • Knesper DJ. A study of referral failures for potentially suicidal patients: a method of medical care evaluation. Hosp Community Psychiatry. 1982 Jan;33(1):49–52. [PubMed]
  • Ludke RL, Stauss FF, Gustafson DH. Comparison of five methods for estimating subjective probability distributions. Organ Behav Hum Perform. 1977 Jun;19(1):162–179. [PubMed]
  • Nurius PS. Emergency psychiatric services: a study of changing utilization patterns and issues. Int J Psychiatry Med. 1983;13(3):239–254. [PubMed]
  • Peterson CR, Beach LR. Man as an intuitive statistician. Psychol Bull. 1967 Jul;68(1):29–46. [PubMed]
  • Schulberg HC, Burns BJ. The nature and effectiveness of general hospital psychiatric services. Gen Hosp Psychiatry. 1985 Jul;7(3):249–257. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust