Hospital and rehabilitation services

Deinstitutionalization has left hospitals with a modified role, in which co ercion and violence are a particularly common problem. Numerous studies, of ten based on comprehensive data sets, have investigated predictors of outco me such as rehospitalization rate, duration of stay and violent incidents. The variance explained by patient characteristics and baseline variables ha s been rather small, however, rendering it of little use for predicting ind ividual cases. Clinical practice in hospitals varies - even more so in part ial hospitalization programmes and seems to depend more on the ideology and policy of the hospital and on the quality of community care services than on patient factors. How policy interventions can influence practice, howeve r, and ultimately improve individual outcome, is still poorly understood. I n the rehabilitation of schizophrenia patients, the relation of specific co gnitive deficits to differential outcomes may facilitate the development of targeted interventions. However, advances in empirical research worthy of the prevailing optimism in the field are still eagerly awaited though. In v ocational rehabilitation, individual placement and support in competitive e mployment has been shown to be a more effective alternative than convention al strategies. In general, there is a trend towards more intensive and indi vidualized specific rehabilitation programmes. Curr Opin Psychiatry 13:215- 219. (C) 2000 Lippincott Williams & Wilkins.