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STATEWIDE GEOGRAPHIC VARIATION IN GERIATRIC PSYCHIATRIC ADMISSIONS
Abstracts scores. Conclusion: A relationship between healthcare proxy completion and diagnosis was noted, with dementia patients most likely to have completed written advance directives. One potential explanation is the urgency of legal documentation in the dementia group. Nonetheless, a large majority of the middle age and elderly psychiatric patients did not have a healthcare proxy. The current push to comply with the PSDA will have to work for a more consistent advance care planning for all psychiatric patients. P64
DEVELOPING A STATEWIDE MEASURE FOR THE EFFECTIVENESS OF GERIATRIC INPATIENT TREATMENT OF DEPRESSION. James Westphal, M.D.; Ronald Horswell, Ph.D.
P
urpose: The purpose of this study was to develop a statewide statistical measure of the effectiveness of inpatient treatment of geriatric depression. Methodology: A Kaplan Mier survival curve for all Louisiana over age 65 Medicare admissions for depression in fiscal year 1995 was constructed using the HCFA MedPro database. ECT-treated patients were treated as a separate group. A literature search was performed to find a suitable comparison group. Results: Survival rates at 1 year were 67% without statistically significant differences for ECT vs. other inpatient treatments. The literature search found minimal studies reporting on geriatric depression rehospitalization rates. Only two studies were found that reported rehospitalization rates at one year in geriatric depression populations. The studies reported 1-year survival rates of (77% and 72%) with smaller sample sizes and more homogenus treatment populations. Conclusion: Rehospitalization rates may be a useful measure of inpatient geriatric depression treatment effectiveness. In this study, the statewide rehospitalization rate was comparable to a smaller group of geriatric patients treated in a single academic medical center. The next step in the development of this measure will be to calculate provider rehospitalization rates and measure the amount of systemic variation. P8
THE LOUISIANA MEDICARE ECT QUALITY IMPROVEMENT PROJECT. James Westphal, M.D.;, Kenneth Sauyke, M.D.;, Jill Rush, M.D.; Sanjaya Kumar, M.D., M.P.H.
T
he first collaborative state-wide psychiatric quality improvement project, initiated by Louisiana Health Care Review, Inc., focused on the practice of inpatient ECT among Medicare patients. Data from the project indicated that the majority of Medicare patients receiving ECT were Caucasian females living at home, in good physical health, in their seventies with a diagnosis of major depression or
Am J Geriatr Psychiatry Supplement, Fall 1999
major depression with psychotic features. The quality indicators for the project included: (documentation of) monitoring of cognitive side effects, monitoring of depressive target symptoms, ECT appropriateness, electrode placement, anesthesia evaluation, and dental examination. An additional indictor (administration of possibly detrimental medication during ECT) was developed based on the recommendation by the study group. At project conclusion, significant improvement occurred in all project indicators. ECT as practiced in the participating hospitals was effective and appropriate. Appropriateness was determined as depression refractory to two medication trails or an emergency due to severe suicidality or physical decompensation secondary to malnourishment. Transient hypertension (13%) and cardiac dysrhythmias (3.5%) which resolved in the recovery period were the most frequent complications. P7
STATEWIDE GEOGRAPHIC VARIATION IN GERIATRIC PSYCHIATRIC ADMISSIONS. James Westphal, M.D.; Ron Horswell, Ph.D.
P
urpose: The study of geographic practice variation in medicine and surgery has caused significant changes in health care policy and the regulation of clinical practice, but studies of psychiatric practice variation are minimal. The purpose of this study was to determine the major sources of statewide geographic variation in geriatric psychiatric admissions. Methodology: The Louisiana 1995 fiscal year Medicare over 65 psychiatric admission rates were calculated from the HCFA MEDPRO database and analyzed using six variables: prospective payment stays (PPS), psychiatric hospital vs. acute general hospital stays, first admissions vs. readmissions, depression admissions, substance abuse admissions, transfers after medical/surgical admissions. Results: High admission rate areas were associated with psychiatric hospitalizations after a medical/surgical hospitalization, the use of acute general hospitals, the use of non PPS stays, and depression admissions. Readmissions and substance abuse admissions were not statistically related to high admission areas. Conclusions: The strongest association with higher geographic admission rates was the use of non-PPS beds in acute general hospitals. This finding in geriatric psychiatric admissions is consistent with the small area analysis literature on medical and surgical admissions. P6
LIFE SATISFACTION IN INSTITUTIONALIZED CENTENARIANS. Marc Zisselman, M.D.; Terri A CutilloSchmitter, M.S.N, R.N.C.S.
O
bjective: To assess life satisfaction among centenarians residing in a long-term care facility. Second, to determine if a simple weekly interpersonal intervention
63
DEVELOPING A STATEWIDE MEASURE FOR THE EFFECTIVENESS OF GERIATRIC INPATIENT TREATMENT OF DEPRESSION. James Westphal, M.D.; Ronald Horswell, Ph.D.
P
urpose: The purpose of this study was to develop a statewide statistical measure of the effectiveness of inpatient treatment of geriatric depression. Methodology: A Kaplan Mier survival curve for all Louisiana over age 65 Medicare admissions for depression in fiscal year 1995 was constructed using the HCFA MedPro database. ECT-treated patients were treated as a separate group. A literature search was performed to find a suitable comparison group. Results: Survival rates at 1 year were 67% without statistically significant differences for ECT vs. other inpatient treatments. The literature search found minimal studies reporting on geriatric depression rehospitalization rates. Only two studies were found that reported rehospitalization rates at one year in geriatric depression populations. The studies reported 1-year survival rates of (77% and 72%) with smaller sample sizes and more homogenus treatment populations. Conclusion: Rehospitalization rates may be a useful measure of inpatient geriatric depression treatment effectiveness. In this study, the statewide rehospitalization rate was comparable to a smaller group of geriatric patients treated in a single academic medical center. The next step in the development of this measure will be to calculate provider rehospitalization rates and measure the amount of systemic variation. P8
THE LOUISIANA MEDICARE ECT QUALITY IMPROVEMENT PROJECT. James Westphal, M.D.;, Kenneth Sauyke, M.D.;, Jill Rush, M.D.; Sanjaya Kumar, M.D., M.P.H.
T
he first collaborative state-wide psychiatric quality improvement project, initiated by Louisiana Health Care Review, Inc., focused on the practice of inpatient ECT among Medicare patients. Data from the project indicated that the majority of Medicare patients receiving ECT were Caucasian females living at home, in good physical health, in their seventies with a diagnosis of major depression or
Am J Geriatr Psychiatry Supplement, Fall 1999
major depression with psychotic features. The quality indicators for the project included: (documentation of) monitoring of cognitive side effects, monitoring of depressive target symptoms, ECT appropriateness, electrode placement, anesthesia evaluation, and dental examination. An additional indictor (administration of possibly detrimental medication during ECT) was developed based on the recommendation by the study group. At project conclusion, significant improvement occurred in all project indicators. ECT as practiced in the participating hospitals was effective and appropriate. Appropriateness was determined as depression refractory to two medication trails or an emergency due to severe suicidality or physical decompensation secondary to malnourishment. Transient hypertension (13%) and cardiac dysrhythmias (3.5%) which resolved in the recovery period were the most frequent complications. P7
STATEWIDE GEOGRAPHIC VARIATION IN GERIATRIC PSYCHIATRIC ADMISSIONS. James Westphal, M.D.; Ron Horswell, Ph.D.
P
urpose: The study of geographic practice variation in medicine and surgery has caused significant changes in health care policy and the regulation of clinical practice, but studies of psychiatric practice variation are minimal. The purpose of this study was to determine the major sources of statewide geographic variation in geriatric psychiatric admissions. Methodology: The Louisiana 1995 fiscal year Medicare over 65 psychiatric admission rates were calculated from the HCFA MEDPRO database and analyzed using six variables: prospective payment stays (PPS), psychiatric hospital vs. acute general hospital stays, first admissions vs. readmissions, depression admissions, substance abuse admissions, transfers after medical/surgical admissions. Results: High admission rate areas were associated with psychiatric hospitalizations after a medical/surgical hospitalization, the use of acute general hospitals, the use of non PPS stays, and depression admissions. Readmissions and substance abuse admissions were not statistically related to high admission areas. Conclusions: The strongest association with higher geographic admission rates was the use of non-PPS beds in acute general hospitals. This finding in geriatric psychiatric admissions is consistent with the small area analysis literature on medical and surgical admissions. P6
LIFE SATISFACTION IN INSTITUTIONALIZED CENTENARIANS. Marc Zisselman, M.D.; Terri A CutilloSchmitter, M.S.N, R.N.C.S.
O
bjective: To assess life satisfaction among centenarians residing in a long-term care facility. Second, to determine if a simple weekly interpersonal intervention
63