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AbstractCrisis intervention is an effective and economical alternative to unnecessary psychiatric hospitalization.

Hospital spending represents approximately one third of total national health spending, and the majority of hospital spending is by public payers. Elderly individuals with long-term care needs are at particular risk for hospitalization. While some hospitalizations are unavoidable, many are not, and there may be benefits to reducing hospitalizations in terms of health and cost. This article reviews the evidence from 55 peer-reviewed articles on interventions that potentially reduce hospitalizations from formal long-term care settings. The interventions showing the strongest potential are those that increase skilled staffing, especially through physician assistants and nurse practitioners; improve the hospital-to-home transition; substitute home health care for selected hospital admissions; and align reimbursement policies such that providers do not have a financial incentive to hospitalize. Much of the evidence is weak and could benefit from improved research design and methodology.

The nursing home resident of today is old and frail. Despite such a frailty, many residents are hospitalized, often with the intention of life-extension. Furthermore, rates of hospitalization varies considerably between countries, regions and institutions, even within smaller geographical areas. Even though relating to the same structural framework and conditions, distance to hospitals for instance, some nursing homes hospitalize considerably more than others.

"The NBER Bulletin on Aging and Health provides summaries of publications like this. You can sign up to receive the NBER Bulletin on Aging and Health by email. We estimate the impact of diabetic drug adherence on hospitalizations, ER visits, and hospital costs, using insurance claims from MarketScan(r) employer data. However, it is often difficult to measure the impact of drug adherence on hospitalizations since both adherence and hospitalizations may be correlated with unobservable patient severity. We control for such unobservables using propensity score methods and instrumental variables for adherence such as drug coinsurance levels and direct-to- consumer-advertising. We find a significant bias due to unobservable severity in that patients with more severe health are more apt to comply with medications. Thus, the relationship between adherence and hospitalization will be underestimated if one does not control for unobservable severity. Overall, we find that increasing diabetic drug adherence from 50% to 100% reduced the hospitalization rate by 23.3% (p=0.02) from 15% to 11.5%. ER visits are reduces by 46.2% (p=.04) from 17.3% to 9.3%. While such an increase in adherence increases diabetic drug spending by $776 a year per diabetic, the annual cost savings for averted hospitalizations are $886 per diabetic, a cost offset of $110 (p=0.02), or $1.14 per $1 spent on drugs"--National Bureau of Economic Research web site

Ontario government statistics have indicated that during the 1960s the proportion of readmissions to psychiatric hospitals doubled to form two thirds of all admissions. Since this pertained to events rather than to individuals, a cohort of patients first admitted in 1969 was followed for 4 years to trace the pattern of readmission and the characteristics of patients at risk of readmission. Routinely returned data were linked and a sample from the greater metropolitan Toronto area was randomly selected. Of the cohort, 31% were readmitted, 8% three or more times. Age and diagnosis distinguished those readmitted. Most with multiple readmissions were under 25 years of age. Although diagnoses were equally distributed on first admission among psychotic, neurotic and other nonpsychotic disorders, with no significant change on readmission or multiple readmission, there was a predictably greater proportion of functional psychoses among the high-risk group and also an equal representation of personality, addictive and the remaining nonpsychotic conditions. The vulnerable few are identifiable early in their intermittent hospital career. It can be concluded that statistics suggesting that two thirds of admissions are readmissions are misleading.

Based on family systems theory, this study examined perceptions of familyfunction and affect of myocardial infarction (MI) patients and their spouses at the time of hospitalization and 3 months later. Research questions were (a) Is there a difference in the perceived satisfaction withfamilyfunctioning and affect between hospitalization and 3 months later? (b) Is there a relationship between perceptions of familyfunctioning and affect? A nonprobability sample of 42 couples completed the Family APGAR and the Affects Balance Scale. Thirtyseven couples completed the same instruments at Time 2,for a return rate of 88%. In contrast to a number of previous studies, perceptions offamilyfunction did not decline between Time 1 and Time 2. At both times, patients and spouses experienced considerable emotional distress, with spouses fanrng worse than patients. Perceptions offamily function and affect balance were significantly correlated for patients at Time 2 and for spouses at both times. It is suggested that family systems nurses assess and intervene with cardiac couples at hospitalization and during convalescence with the goal of improving affect and perceptions of family function.