Measurement of Discontinuity of Psychiatric Inpatient Care

Abstract

CONTINUITY of psychiatric care is often said to have special virtue. WVhat is meant by such continuity, however, needs clarification. For example, a recent publication of the National Institute of Mental Health (1) relative to community mental health centers contains these statements: Since the elements of the center need not be under one roof, nor even under ia single sponsorship, the administration of the various components must be done in such a manner that the goal of smooth continuity of care is achieved. In some community centers, such as Colorado's Fort Logan State Hospital, emphasis is placed on maintaining continuity of therapists. Since the object is to provide a -complete circle of treatment for patients at the community level . . . The third idea-to provide a complete circle of treatment-has a somber sound, and the first two suggest restless bedfellows. The present study, in an effort to define and quantify continuity of care, at least in a negative way, determines lack of early continuity of care among inpatients new to mental hospitalsin other words, determines the frequency of 'discontinuity of care. Two measures are used. One is the rate at which all persons newly admitted to psychiatric inpatient care had a second inpatient experience in a psychiatric facility other than the facility of initial entry. The second is confined to those patients who had another admission. The first measure gives an estimate of the risk of discontinuity of psychiatric inpatient care, while the second describes the pattern of discontinuity when it occurs. Clearly, even if a patient resumes treatment in the same hospital, there are definitions of discontinuity of care with which the regimen might conform. For example, in the same hospital the second episode might involve different caretaking personnel and a different immediate physical environment. It is presumed here, however, that a different hospital does commonly result in some type of discontinuity and that the measures proposed provide minimum estimates of its frequency. Quantitative studies by others bearing directly on continuity or discontinuity of psychiatric inpatient care were not found.