Predictors of admission in first-episode psychosis: developing a risk adjustment model for service comparisons.
ABSTRACT The aim of this study was to develop a risk adjustment model based on hospital admissions that would enable comparison between services for patients with a first episode of psychosis.
Candidate predictor variables for hospital admission were identified in a literature review, from which an expert panel selected 12 potential risk adjustment variables by using a structured process, the Template for Risk Adjustment Information Transfer. Multivariable logistic regression modeling with the 12 variables was used to develop models in one cohort of first-episode psychosis patients (N=297); these models were validated with data from a second cohort (N=309). The C statistic, a measure of model discrimination, was calculated to assess model performance.
In the data from the development sample, prior hospitalization was the only significant predictor of hospital admissions within one year of enrollment in the first-episode psychosis program (odds ratio [OR]=1.88, p=.05). Hospital admissions after two and three years from admission to the program were significantly associated with higher levels of initial positive symptoms (OR=1.07, p=.02; OR=1.06, p=.02, respectively), and prior hospitalizations (OR=2.72, p=.001; OR=3.34, p<.001, respectively). The logistic models performed well, with C statistics ranging from .72 to .74 for the three outcomes, where a value of 1.0 implies perfect model discrimination. In the validation data the C statistics were slightly lower, ranging from .67 to .72.
According to the C statistic estimates, the model developed provided good discrimination and was relatively robust in predicting hospitalization of first-episode psychosis patients.
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ABSTRACT: The objective of this study was to assess the external validity of hospitalization as an outcome measure for first-episode psychosis services. A two-year, prospective cohort design was used to examine the associations between hospitalization, general psychopathology, and quality of life in a cohort of 606 participants treated for a first episode of psychosis. In bivariate analyses, general psychopathology and quality of life were each significantly associated with hospitalization at both time points. After analyses controlled for all covariates in the logistic models, both clinical measures continued to be significantly correlated with hospitalization at both one and two years. These results validate hospitalization as an outcome measure for first-episode psychosis services, and they extend the existing research showing a relationship between hospitalization and process measures to include other valid and reliable clinical measures.Psychiatric services (Washington, D.C.) 03/2012; 63(3):280-2. DOI:10.1176/appi.ps.201100118
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ABSTRACT: The purpose of study was to identify a list of performance measures for schizophrenia treatment services and to assemble a multistakeholder group to reach consensus on a core list. The study was conducted in two stages: first, a systematic review of the literature was conducted to identify a comprehensive list of measures; second, a consensus-building technique, the Delphi process, was used with participants from six groups of stakeholders: schizophrenia experts, mental health clinicians, mental health administrators, the payer (the Alberta Ministry of Health and Wellness), patients, and family members. Thirty stakeholders participated in three rounds of self-completed questionnaires. The degree of consensus achieved in the Delphi process was defined as the semi-interquartile range for each measure. Ninety-seven measures were identified in the literature review. The Delphi method reduced the list to 36 measures rated as essential. The measures address eight domains of service-level evaluation: acceptability, accessibility, appropriateness, competence, continuity, effectiveness, efficiency, and safety. Despite the diversity in backgrounds of the stakeholder groups, the Delphi technique was effective in moving participants' ratings toward consensus through successive questionnaire rounds. The resulting measures reflected the interests of all stakeholders. Several further steps are required before these measures are implemented and include working toward reliability and validity of specific measures, assessing the feasibility and cost-effectiveness of collecting the data, and finally, undertaking risk adjustment for outcome measures.Psychiatric services (Washington, D.C.) 04/2012; 63(6):584-91. DOI:10.1176/appi.ps.201100453
- Psychiatric services (Washington, D.C.) 07/2012; 63(7):721; author reply 721-2. DOI:10.1176/appi.ps.20120p721