Predictors of admission in first-episode psychosis: developing a risk adjustment model for service comparisons.

OBJECTIVE: The aim of this study was to develop a risk adjustment model based on hospital admissions that would enable comparison between services for patients with a first episode of psychosis. METHODS: Candidate predictor variables for hospital admission were identified in a literature review, from which an expert panel selected 12 potential risk adjustment variables by using a structured process, the Template for Risk Adjustment Information Transfer. Multivariable logistic regression modeling with the 12 variables was used to develop models in one cohort of first-episode psychosis patients (N=297); these models were validated with data from a second cohort (N=309). The C statistic, a measure of model discrimination, was calculated to assess model performance. RESULTS: In the data from the development sample, prior hospitalization was the only significant predictor of hospital admissions within one year of enrollment in the first-episode psychosis program (odds ratio [OR]=1.88, p=.05). Hospital admissions after two and three years from admission to the program were significantly associated with higher levels of initial positive symptoms (OR=1.07, p=.02; OR=1.06, p=.02, respectively), and prior hospitalizations (OR=2.72, p=.001; OR=3.34, p<.001, respectively). The logistic models performed well, with C statistics ranging from .72 to .74 for the three outcomes, where a value of 1.0 implies perfect model discrimination. In the validation data the C statistics were slightly lower, ranging from .67 to .72. CONCLUSIONS: According to the C statistic estimates, the model developed provided good discrimination and was relatively robust in predicting hospitalization of first-episode psychosis patients.

A comparison of early psychosis treatment services using consensus and evidence-based performance measures: moving towards setting standards.

OBJECTIVE: This study used data from two Canadian early psychosis programs to assess the feasibility of using common performance measures and to assess the extent to which each program meets suggested standards for early intervention. METHODS: Data were extracted from administrative databases and supplemented by health records for 332 individuals admitted to two services in order to calculate values for 19 performance indicators for January 2000 to January 2004. Inter-rater reliability was established for data abstraction. RESULTS: The two samples had similar demographic and clinical profiles. There were no statistically significant differences in 1-, 2- and 3-year admission rates (year 1: 27% vs. 30%, P=0.625; year 2: 31% vs. 38%, P=0.248; year 3: 35% vs. 42%, P=0.260), duration of untreated psychosis (DUP) (24 vs. 28 weeks; P=0.844) and positive symptom remission at 1 year (72% vs. 78%; P=0.285). There were statistically significant differences between the two services in mean wait time (18 vs. 13 days; P=0.045), proportion of patients on second-generation anti-psychotics at 1 year (75% vs. 89%; P=0.002), and proportion of patients adherent to antipsychotic medication for a minimum of 12 months (76% vs. 83%; P=0.007). CONCLUSION: The data provides useful information on the feasibility of implementing key performance measures across early psychosis programs to assess the extent to which they are meeting standards for such services.

Promotion of healthy weights at preschool public health vaccination clinics in Calgary: an obesity surveillance program.

OBJECTIVE: To evaluate the acceptability and feasibility of a surveillance program of overweight and obesity in preschool children in Calgary, and to provide advice for families to promote healthy weights. PARTICIPANTS AND SETTING: Children (mean age 4.9+/-0.6 years) attending pilot-site clinics in September 2002 and all clinics in Calgary between February 2003-December 2003 (n=7048). INTERVENTION: The growth assessment protocol and resources supported a three-pronged approach to promote healthy weights (healthy eating, active living and positive body image). Public health nurses were trained in standardized measurement techniques and information resources. Links with physicians were made to facilitate continuity of care. Children's weight and height measurements were plotted on the Weight-for-Stature growth chart and used to identify children as obese (> or =95th percentile), healthy weight (> or =5th, <95th) or underweight (<5th). Subsequent analysis calculated the Body Mass Index (BMI)-for-Age to identify overweight children (> or =85th, <95th percentile). The protocol was pilot tested and subsequently implemented in all Calgary public health clinics. OUTCOMES: The majority (98%) of parents were either very happy or happy with information received during the visit. Public health nurse counselling confidence significantly improved after the pilot (p<0.001). Data indicated that 9% of children were obese, 15% were overweight and 3% were underweight. INTERPRETATION: This approach to identifying children's weight status appeared satisfactory to stakeholders, maximized use of existing resources to establish a surveillance program for Calgary, and provided an opportunity to give parents health-promoting advice on healthy weights.