When exploring avenues to improve patient clinical outcomes, one intriguing factor to consider is the extent of a psychiatrist’s influence on their patients’ outcomes. Do outcomes vary by psychiatrist, and do case mix factors explain the variance?
MHO analyzed data from 69 attending psychiatrists that each treated a minimum of 400 adult inpatients over the last two years. The final dataset included 72,223 patients, each with recorded admission or discharge BASIS-321 scores.
Five psychiatrists with the highest average discharge severity were identified as those with the “worst” and highest discharge severity. Similarly, the 5 psychiatrists with the lowest average discharge score were identified as the lowest discharge severity and “best” group. All other psychiatrists were considered to have a ‘typical’ discharge severity. It’s worth pointing out that the high severity group of psychiatrists all have an average discharge severity more severe than 1 in 5 admitting adult inpatients. In other words, on average these psychiatrists are discharging inpatients at a severity worse than 1 in 5 patients who are beginning inpatient treatment. Similarly, each “highest discharge severity” psychiatrist has an average discharge severity more than twice that of any “lowest discharge severity” psychiatrist.
While it appears psychiatrists do in fact vary in terms of how severe their patients are at discharge which could be interpreted as differences in psychiatrist performance, it’s possible case mix could play a part. In simpler terms, it may be that psychiatrists with the highest discharge scores are treating more “difficult” patients who admit with a higher severity. Figure 2 does support this idea, showing that psychiatrists with the highest average discharge severity also have the highest average admission severity, whereas psychiatrists in the lowest and middle discharge severities do not differ from each other in terms of admission severity. Fortunately, there are ways to account for this!
One such way is to compare the three groups of psychiatrists among like patients, that is those who admitted with similar admission severity. Patients were divided into three distinct groups: those with low admission severity, those with moderate admission severity, and those with high admission severity. Each patient’s discharge severity was then graphed according to which group their psychiatrist belongs to.
These findings illustrate that psychiatrists with the lowest discharge severity overall also had the lowest discharge severity regardless of admitting severity. Notably, the most significant disparity in psychiatrist discharge scores was observed within the group of patients with high admission severity. Additionally, it’s worth mentioning that the high discharge severity psychiatrist group exhibited more variability in their discharge scores in comparison to the low severity group, suggesting a consistent level of effectiveness among the latter group. Consequently, while admission severity appears to be a relevant factor in clinical outcomes, it does not account for all variations. Psychiatrists exert a discernible influence on patient outcomes that extends beyond the impact of admitting severity.
Of course, there may be other psychiatrist related factors at play that cannot be accounted for in this analysis, such as years of experience, as well as non-psychiatrist factors like staffing ratios and social determinants of health. Nonetheless, a patient’s psychiatrist does appear to influence their outcomes. This important role in patient outcomes must be acknowledged by psychiatrists themselves as well as BH facilities. It is likely those psychiatrists whose patients consistently achieve good clinical outcomes scores have valuable learnings and/or skills that can be shared with others, thus improving outcomes for all patients.