Effects on processes and costs of care associated with the addition of an internist to an inpatient psychiatry team.
OBJECTIVE
This study examined the effects of collaboration between an internist and psychiatrists on the processes and cost of care among psychiatric inpatients.


METHODS
A randomized controlled study was performed on the psychiatric inpatient units of an academic medical center. All inpatients who were admitted to the units between March 2001 and January 2002 were asked to participate in the study. Patients in the intervention group met with an internist who participated in their care by communicating with the patients' primary care physicians, assessing needs, updating appropriate health maintenance services, managing chronic and acute medical problems, and attending hospital work rounds. Patients in the usual-care group received usual care. The processes of care were measured by examining 17 categories that involved assessment of needs, coordination of care, and completion of health maintenance services. Resource use was measured by examining hospital charges and length of stay.


RESULTS
A total of 139 adults participated in the study: 55 were in the intervention group and 84 were in the usual-care group. Patients in the intervention group showed significant improvement in 12 of the 17 categories of the processes of care. Overall, no differences were found in hospital charges or length of stay.


CONCLUSIONS
Adding an internist to an inpatient psychiatric team is an effective way of improving care for this traditionally underserved population without increasing cost.
Rubin
Alan S
AS
University of Vermont College of Medicine, 371 Pearl Street, Burlington, Vermont 05401, USA. alan.rubin@uvm.edu
Littenberg
Benjamin
B
Ross
Robert
R
Wehry
Susan
S
Jones
Marilee
M
D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D015438:Health Behavior; D006304:Health Status; D017722:Hospital Charges; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000534:rehabilitation*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D010348:Patient Care Team; D017064:Process Assessment, Health Care; D011567:Psychiatric Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D011570:Psychiatry; D014481:United States