QUALITY OF CARE FOR DEPRESSED ELDERLY PATIENTS HOSPITALIZED IN THE SPECIALTY PSYCHIATRIC UNITS OR GENERAL MEDICAL WARDS

Background: Studies to assess quality of care have become increasingly important for research and policy purposes. Objective: To evaluate th e difference in quality of care between elderly depressed patients hos pitalized in specialty psychiatric units and those hospitalized in gen eral medical wards. Methods: We reviewed retrospectively the medical c harts of 2746 patients with depression hospitalized in 297 general med ical hospitals in five different states. Quality of care was assessed by clinical review of explicit and implicit information contained in t he medical records of patients in specialty psychiatric units (n = 129 5) and general medical wards (n = 1451). We also used other secondary data sources to determine postdischarge outcomes. Results: We found th at (1) a higher percentage of admissions on the psychiatric units were considered appropriate, (2) overall psychological assessment was bett er on the psychiatric unit, (3) patients were more likely to receive p sychological services on the psychiatric wards but more likely to rece ive traditional general medical services on medical wards, (4) there w ere more inpatient general medical complications on the psychiatric wa rds, and (5) implicit measures of clinical status at discharge were be tter for those on the psychiatric unit. Conclusions: Although limited by reliance on medical record abstraction and a retrospective study de sign, our data indicate that the quality of care for the psychological aspects of the treatment of depression may be better on psychiatric u nits, while the quality of general medical components of care may be b etter on general medical wards.