This article examines the characteristics associated with Alternate Level of Care (ALC) status in mental health in-patient units across Ontario. Using assessment information from the Resident Assessment Instrument–Mental Health, the prevalence of ALC episodes, resource utilization associated with ALC, and demographic and diagnostic characteristics of ALC patients are examined. The effective management of ALC patients should be an important priority for all stakeholders involved in mental health services delivery in Canada.
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References
1.
Cancer Care Ontario (CCO). Alternate level of care. Cancer Care Ontario. Available at:https://www.cancercare.on.ca/ocs/alc/. Accessed December 3, 2014. Published October 11, 2005.
2.
CostaAPPossJWPeirceTHirdesJP. Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region. BMC Health Serv Res. 2012;12(1):172. doi:10.1186/1472-6963-12-172.
3.
BarnableAWelshDLundriganEDavisC. Analysis of the influencing factors associated with being designated alternate level of care. Home Health Care Manag Pract. 2015;27(1):3–12. doi:10.1177/1084822314539164.
Access to Care—Alternate Level of Care Informatics, Cancer Care Ontario. Provincial Monthly Alternate Level of Care Performance Summary; 2014. Toronto, Ontario.
6.
Ministry of Health and Long-term Care. Annual Report of the Office of the Auditor General of Ontario - Chapter 3 - Section 3.02 - Discharge of Hospital Patients; 2010. Available at:http://www.auditor.on.ca/en/reports_en/en10/302en10.pdf. Accessed February 13, 2015.
7.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed). Arlington, VA: American Psychiatric Association; 2013.
8.
PooleRPearsallARyanT. Delayed discharges in an urban in-patient mental health service in England. Psychiatr Bull. 2014;38(2):66–70.
9.
TriemanNLeffJ. Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community: TAPS Project 44. Br J Psychiatry. 2002;181(5):428–432. doi:10.1192/bjp.181.5.428.
10.
KellyAWatsonDRaboudJBilskerD. Factors in delays in discharge from acute-care psychiatry. Can J Psychiatry. 1998;43(5):496–501.
11.
ParkJMParkLTSiefertCJAbrahamMEFryCRSilvertMS. Factors associated with extended length of stay for patients presenting to an urban psychiatric emergency service: a case-control study. J Behav Health Serv Res. 2008;36(3):300–308.
HirdesJPMarhabaMSmithTF. Development of the Resident Assessment Instrument–Mental Health (RAI-MH). Hosp Q. 2001;4(2):44–51.
14.
MartinLHirdesJPMorrisJNMontaguePRabinowitzTFriesBE. Validating the Mental Health Assessment Protocols (MHAPs) in the Resident Assessment Instrument Mental Health (RAI-MH). J Psychiatr Ment Health Nurs. 2009;16(7):646–653.
15.
HirdesJPLjunggrenGMorrisJN. Reliability of the interRAI suite of assessment instruments: A 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277.
16.
GibbonsCDuboisSRossS. Using the Resident Assessment Instrument–Mental Health (RAI-MH) to determine levels of care for individuals with serious mental illness. J Behav Health Serv Res. 2008;35(1):60–70.
17.
JonesKPerlmanCMHirdesJPScottT. Screening cognitive performance with the Resident Assessment Instrument for Mental Health (RAI-MH) Cognitive Performance Scale. Can J Psychiatry. 2010;55(11):736–740.
18.
NeufeldEPerlmanCMHirdesJP. Predicting inpatient aggression using the interRAI Risk of Harm to Others clinical assessment protocol. J Behav Health Serv Res. 2012;39(4):472–480.
19.
PerlmanCMHirdesJPBarbareeH. Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment. BMC Health Serv Res. 2013;13(1):15.
20.
FoebelADHirdesJPHeckmanGAKergoatMJPattenSMarrieRA. Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental healthcare settings: a validity study. BMC Health Serv Res. 2013;13(1):457.
