The proposed research is designed to study the effects of a liaison psychiatry intervention on the cost of health care for orthopedic patients in contrast to a comparison non-liaison service. The specific hypotheses are that a liaison psychiatric intervention on an inpatient orthopedic unit reduces length of stay and hospital costs and increases the frequency of return to home for those previously at home. The proposed research further hypothesizes that a liaison psychiatric intervention will increase the use of mental health resources and costs during the ninety days post-discharge, for example, increase in visits to a mental health care provider and in the utilization of a mental health hospital. This study will also evaluate whether the intervention decreases psychological morbidity, such as depression, anxiety or organicity during the hospital stay and six and twelve weeks post-discharge. These hypotheses will be tested through the administration of a semi-structured interview, a chart review and patient log, the Beck Depression Inventory, the Arthritis Impact Measurement Scale, the Spielberger State-Trait Anxiety Inventory, a disease staging evaluation, tests for organicity, and the Research Diagnostic Criteria. The subjects will be consecutively admitted patients to three orthopedic units (two at Northwestern Memorial Hospital, and one at MSH) who meet the following inclusion criteria: 1 - female, 2 - between the ages of 64 and 76 and 3 - admitted to the hospital with a broken hip. Each patient will be interviewed at admission, at discharge at six weeks post-discharge and at twelve weeks post-discharge. The design will consist of a three phased implementation of psychiatric liaisons on the three units under study. The first twelve month period will be a base line phase on all three units. During the second phase, liaison psychiatry interventions will be introduced in one Northwestern unit and in the MSH unit. Finally, during the third phase, all three units will have an active liaison intervention. The proposed research is the first random assignment experimentally controlled evaluation of a psychiatric liaison intervention. Its results should have important implications for the policies and preactise of psychiatry in medical settings.
| Strain, J J; Lyons, J S; Hammer, J S et al. (1991) Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients. Am J Psychiatry 148:1044-9 |
| Pressman, P; Lyons, J S; Larson, D B et al. (1990) Religious belief, depression, and ambulation status in elderly women with broken hips. Am J Psychiatry 147:758-60 |
| Lyons, J S; Strain, J J; Hammer, J S et al. (1989) Reliability, validity, and temporal stability of the geriatric depression scale in hospitalized elderly. Int J Psychiatry Med 19:203-9 |
