Impacts of Patient-Centered Inpatient Psychiatric Care on Trust and Post-Discharge Engagement with Care

Research Objective

Inpatient psychiatry lacks empirical evidence for its benefits, with some evidence of iatrogenic harm. Research suggests that safety events, including restraint and seclusion, are not uncommon. Within 30-days of discharge, the risk for suicide is 180 times the rate in the general population, about a third of patients have an unplanned readmission, and only about 50% have a follow-up appointment. These increased risks for negative outcomes and disengagement with care might relate to the quality of inpatient care experiences, yet research investigating these associations is sparse.

The current study aimed to understand the relationship between patients' reports of patient-centered care (PCC) in inpatient psychiatry and proximal outcomes of trust and post-discharge engagement with care. This is the first known study to examine these relationships.

Study Design

We used a retrospective cohort design. Participants were recruited online in 2021 and administered a survey. PCC was measured using a valid and reliable instrument, the Combined Assessment of Psychiatric Environments. Participants were asked to report the degree of trust they had in the hospital at time of admission, the extent to which their trust in mental health providers decreased or increased due to their hospitalization, the extent to which their willingness to disclose distressing thoughts to outpatient providers decreased or increased due to their hospitalization, and the extent to which their willingness to go to the hospital voluntarily decreased or increased due to their hospitalization. Participants also reported global impacts of the hospitalization on wellbeing (positive, negative, mixed, neutral), whether they received follow-up care within 30-days of discharge, clinical characteristics, and demographic characteristics.

Logistic regression models were fit for each outcome, with PCC serving as the primary predictor. Models controlled for baseline trust/expectations in the quality of hospital care at time of admission, voluntary status, suicidality, prior admissions, demographic characteristics, and year.

Population Studied

The population included adults (18+) who were hospitalized for psychiatric treatment in the United States within the past five years.

Principal Findings

A total of 733 participants completed the survey. Relative to those in the top quartile of PCC, those in the bottom quartile were more likely to have their trust reduced (predicted probability [PP] = 0.75 versus 0.40, p < 0.001), willingness to disclose distressing thoughts reduced (PP = 0.63 versus 0.18, p < 0.001), willingness to go to the hospital voluntarily reduced (PP = 0.86 versus 0.08, p < 0.001), were more likely to report that the hospitalization had only a negative impact (PP = 0.53 versus 0.02, p < 0.001), and were less likely to have a 30-day follow-up (PP = 0.68 versus 0.88, p < 0.001).

These patterns persisted when examining positive outcomes of increased trust and engagement, and were robust even when restricted to those hospitalized on an involuntary basis.

Conclusions

Low ratings of PCC were associated with reported reductions in trust and decreased engagement, whereas high PCC was associated with increased trust and increased engagement.

Implications for Policy or Practice

These findings demonstrate the importance of PCC on outcomes. Payers and policy makers should expand patient experience measurement to inpatient psychiatry (e.g., HCAHPS). Systematic measurement of PCC could be used within feedback and incentive designs.

Primary Funding Source

National Institutes of Health.