MEASURING QUALITY OF CARE IN PSYCHIATRIC EMERGENCIES - CONSTRUCTION AND EVALUATION OF A BAYESIAN INDEX

Objective. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. Data Sources/Study Setting. The study used primary data collect ed over a 12-month period from two urban hospitals in the Northeast. O ne had 700 inpatient beds, an inpatient psychiatric unit, and communit y mental health personnel located in the emergency department. The oth er had 300 beds but none of the other hospital's features. Study Desig n. The index was developed by a panel of experts in emergency psychiat ry using a subjective Bayesian statistical methodology and was evaluat ed in terms of its ability to (1) predict a second panel's judgments o f quality; (2) predict a specific quality-related patient outcome, i.e ., compliance with follow-up recommendations; (3) provide a reliable m easurement procedure; and (4) detect variations in patterns of emergen cy department practices. Data Collection/Extraction Methods. Data were collected on 2,231 randomly selected emergency psychiatric patients ( psychiatric diagnosis, alcohol abuse, nonverbal patients experiencing a psychiatric emergency, and patients with somatic complaints such as life crisis) treated in the emergency departments of the two hospitals . Principal Findings. The index predicted physician judgments of quali ty, was reliable, exhibited sufficient variation in scores, and was st rongly associated with patient compliance. Conclusions. The study demo nstrated that a subjective Bayesian model can be used to develop a rel iable and valid index for measuring quality of care, with potential fo r practical application in management of health services.