Patient Diagnostic Differences and Demographics at an Adult Crisis Stabilization Unit
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MADELYN CABRERA, PSY.D. JESUS PEREZ, PSY.D. CITRUS HEALTH NETWORK, INC HIALEAH, FL Patient Diagnostic Differences and Demographics at an Adult Crisis Stabilization Unit
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Patient Diagnostic Differences and Demographics at an Adult Crisis Stabilization Unit. Madelyn Cabrera, Psy.D . Jesus Perez, Psy.D . Citrus Health Network, Inc Hialeah, FL. Adult Crisis Stabilization Unit (ACSU). A designated Baker Act receiving facility 24 bed capacity - PowerPoint PPT Presentation
Transcript of Patient Diagnostic Differences and Demographics at an Adult Crisis Stabilization Unit
MADELYN CABRERA, PSY.D.JESUS PEREZ, PSY.D.
CITRUS HEALTH NETWORK, INCHIALEAH, FL
Patient Diagnostic Differences and Demographics at an Adult
Crisis Stabilization Unit
Adult Crisis Stabilization Unit (ACSU)
A designated Baker Act receiving facility 24 bed capacity Adult population Length of stay varies, most under 1 week
Admission Status Voluntary admission Involuntary admission
Adult Crisis Stabilization Unit (ACSU)
Admission Criteria
Treatment Protocol
Discharge Criteria
Literature Review
Bowers et al. (2008) conducted an extensive literature review on Psychiatric Intensive Care Units
Findings: Mean patient age: 30’s Majority of patients were male Schizophrenia: about 50 % of patients Next largest group: Mania at 20% Majority were single and unemployed Mean lengths of stay of seven days or less
Literature Review: Diagnostic Differences
Berg (2009) examined referrals to an acute psychiatry department at day and night for diagnostic differences
Findings: 47.9% were female and 52% were male Patients with psychotic disorders comprised (26%),
affective disorders 25%, substance abuse disorders (17%), personality disorders (13%), and crises/anxiety disorders (12%)
Mean stay: less than 9 days
Literature Review: Diagnostic Differences
Blader (2011) examined data from facility-level surveys regarding diagnostic trends from acute care inpatient services in U.S. from 1996 to 2007
Diagnostic trends noted: Anxiety diagnoses became less likely throughout survey
years Impairments and behavioral disturbances of hospitalized
patients may have grown more acute Patients with psychotic disorder diagnoses continued to
have LOSs that remained the highest
Literature Review: Diagnostic Differences
Primary Dx
% of Population
LOS
Substance 28.3 4.40Depression 26.8 5.70Psychosis 20.3 10.68Bipolar 17.6 7.16Anxiety 4.53 3.66Other 2.50 6.94
2006-2007, Adults
United States 2010 Census
308.7 million people resided in the U.S. on April 1st, 2010
In June 2013, U.S. Census estimate was 316,057,326
In regards to ethnicity/race in 2010 Census: Largest growth was seen in Hispanic population: 50.5
million Non-Hispanic population grew relatively slower over
the decade at about 5 percent
U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
United States 2010 Census
Hispanic/Latino Origin and Race
Hispanic or LatinoNot Hispanic or LatinoWhite Alone
U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
United States 2010 Census
Race/Ethnic Groups
WhiteBlack or African AmericanAmerican Indian and Alaska NativeAsianNative Hawaiian or Other Pacific IslanderOther Race
U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
Miami-Dade County 2010 Census
2,496,435 million people resided in Miami-Dade
The largest Racial or Ethnic Group: Hispanic at 65 percent Black/African American, 17.1 percent White, 15.4 percent Others, 2.5 percent
Miami-Dade County is the 1st most populated county in Florida
U.S. Census Bureau. (2013, May). 2006-2010 American Community Survey 5 Year Estimates. Retrieved June 26, 2013, from http://www.census.gov/acs/www/data_documentation/summary_file/
Miami-Dade County 2010 Census
Race/Ethnic Groups
HispanicWhiteBlack/African Amer-icanAmerican IndianAsianPacific Islander
U.S. Census Bureau. (2013, May). 2006-2010 American Community Survey 5 Year Estimates. Retrieved June 26, 2013, from http://www.census.gov/acs/www/data_documentation/summary_file/
Miami-Dade County 2010 Census
Additional Facts: Population growth of 11 percent for Miami-Dade
Non-Hispanic White population: 17.7 percent decline Non-Hispanic Black/African American population: 0.3
percent decline
Median Age of Females: 39.4 Median Age of Males: 36.9
Miami-Dade County Research Section, Department of Planning and Zoning. (2011, May). 2006-2010 2010 Census Data: Demographics of commission districts in Miami-Dade. Retrieved June 26, 2013, from http://www.miamidade.gov/redistricting/library/district-demographics.pdf
Research Question
How does the ACSU at Citrus Health Network in Miami-Dade County compare to the literature on diagnostic trends and other inpatient admission characteristics?
What are the implications of this data?
Method
Data Source Analyzed archival data from 2001 to 2010
Age, gender, primary diagnoses, and total length of stay
Analysis Utilized Comparisons made through SPSS with crosstabs
Results
Frequencies of our sample: N=8216 Average age: 42.20 Average length of stay: 4 days Gender:
Females: 46 % Males: 54 %
Gender
FemalesMales
Results
Primary Admission Psychosis 39.2% Depressive 16.9% Bipolar 12.3% Anxiety 0.8% Adjustment 11.9% Alcohol /Substance Related 12.9% Delirium/Dementia 2.3%
Results
Axis I % Females % MalesDepression 64.7 35.3Psychosis 40.8 59.2Bipolar 52.4 47.6Anxiety 50.8 49.2Substance 25.6 74.4Conduct 25 74Developmental 0 100Dementia 34.8 65.2
Results
Axis I 01’ 02’ 03’ 04’ 05’ 06’ 07’ 08’ 09’ 10’
Depression
20.5 20.2 20.1 19.8 17.7 12.1
15.6
14.3
15.7
14.8
Psychosis 49 43.5 38.3 42.7 39 41.1
37.2
35.5
34.9
34.7
Bipolar 6.8 9.5 12.9 10.4 12.2 11.1
12.3
13.6
19.4
18.8
Anxiety .7 1.1 .3 .9 .6 1.0 .6 .5 1.2 1.0
Substance
6.9 9.1 11.0 12.1 14.1 17.1
17.1
18.7
13.0
12.4
Conduct 20.5 20.2 20.1 19.8 17.7 12.1
15.6
14.3
15.7
14.8
Develop. 0 0 0 0 0 .01 0 .01 0 0Dementia 2.4 1.2 3.3 2.6 2.5 2.6 2.2 2.8 2.4 1.1
Results
Gender LOS Age
Female 3.80 43.35
Male 3.93 41.22
Total 3.86 42.20
Results
Diagnosis LOS Average NumberAdjustment 1.44 975Anxiety 2.12 65Bipolar 3.90 1014Dementia/Delirium 2.28 187Depressive 3.40 1385Psychosis 5.68 3222Substance Related 2.12 1061
Results
Reason for Admission
Frequency Percent
Suicidal Threat/Ideation
2892 35.2
Suicidal Attempt 300 3.7Self Injurious Behaviors
124 1.5
Homicidal Threats/ideation
148 1.8
Aggressive Behaviors
1154 14.0
Neglect 225 2.7Psychosis 751 9.1Others 1321 16.6
Discussion
Compared to the literature, there is a higher frequency of psychosis
Diagnostic Trends
Limitations
Skewed sample, primarily Hispanic
Focuses on one particular crisis unit
Future Directions
Closer look at Characteriological Features
Any correlation between psychosis and substance use
Control variables for transferred patients
Protective and Risk factors
References
Berg. J. E. (2009). Referrals to an acute psychiatry department at day and night. Are there diagnostic differences? Journal of Psychiatric Intensive Care, 5, 95-98.
Blader, J.C. (2011). Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Archives of General Psychiatry. Published online August 1, 2011.
Bowers et al. (2008). Psychiatric intensive care units: A literature review. International Journal of Social Psychiatry, 54, 56-68.
Questions?
