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Grayson Norquist, MD, MSPH; Kenneth B. Wells, MD, MPH; William H. Rogers, PhD; Lois M. Davis, PhD; Katherine Kahn, MD; Robert Brook, MD

Arch Gen Psychiatry. 1995;52(8):695-701.

Abstract
Background
Studies to assess quality of care have become increasingly important for research and policy purposes.

Objective
To evaluate the difference in quality of care between elderly depressed patients hospitalized in specialty psychiatric units and those hospitalized in general medical wards.

Methods
We reviewed retrospectively the medical charts of 2746 patients with depression hospitalized in 297 general medical hospitals in five different states. Quality of care was assessed by clinical review of explicit and implicit information contained in the medical records of patients in specialty psychiatric units (n=1295) and general medical wards (n=1451). We also used other secondary data sources to determine postdischarge outcomes.

Results
We found that (1) a higher percentage of admissions on the psychiatric units were considered appropriate, (2) overall psychological assessment was better on the psychiatric unit, (3) patients were more likely to receive psychological services on the psychiatric wards but more likely to receive traditional general medical services on medical wards, (4) there were more inpatient general medical complications on the psychiatric wards, and (5) implicit measures of clinical status at discharge were better for those on the psychiatric unit. Although limited by reliance on medical record abstraction and a retrospective study design, our data indicate that the quality of care for the psychological aspects of the treatment of depression may be better on psychiatric units, while the quality of general medical components of care may be better on general medical wards.

Conclusions
Although limited by reliance on medical record abstraction and a retrospective study design, our data indicate that the quality of care for the psychological aspects of the treatment of depression may be better on psychiatric units, while the quality of general medical components of care may be better on general medical wards.

Author Affiliations
From the National Institute of Mental Health, Rockville, Md (Dr Norquist); the Departments of Psychiatry (Dr Wells) and Medicine (Drs Kahn and Brook), University of California—Los Angeles; and RAND, Santa Monica, Calif (Drs Wells, Rogers, Davis, Kahn, and Brook).

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