Quality of Inpatient Psychiatric Care at VA, Other Government, Nonprofit, and For-Profit Hospitals: A Comparison

Objective: Little is known about the quality of inpatient psychiatric care. This study examined associations between performance on seven measures of inpatient psychiatric quality and hospital ownership.

Methods: The study design was a cross-sectional analysis of The Joint Commission's 2014 inpatient psychiatric hospital quality measures. The measures evaluate admission screening for violence risk, substance use, psychological trauma history, and patient strengths; use of seclusion and restraint; the practice of discharging patients on multiple antipsychotics; providing appropriate justification when patients are discharged on multiple antipsychotics; creation of continuing care plans; and transmission of care plans to the next level of care. Participants were 665 inpatient psychiatric facilities accredited by The Joint Commission.

Results: The mean±SD percentage of patients who received admission screening was 90%±21%; multiple antipsychotics at discharge, 11%±10%; appropriate justification for use of multiple antipsychotics at discharge, 53%±33%; a continuing care plan, 88%±22%; and transmission of the care plan to the next level of care, 82%±23%. Restraint was used for .32±1.1 hours per 1,000 patient hours, and seclusion was used for .27±.8 hours per 1,000 patient hours. Hospital performance on a given measure did not necessarily predict performance on other measures. Government hospitals were low performers, and hospitals owned by the U.S. Department of Veterans Administration (VA) performed worst.

Conclusions: Lack of correlation across measures suggests either that inpatient psychiatric care quality is multidimensional or that it is unreliably assessed. Hospital ownership strongly predicted performance, and VA hospitals performed relatively poorly across most measures.