Date of Award

2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Bridgette M. Brawner

Abstract

Patients with psychotic disorders face a multitude of medical health disparities in addition to psychological symptoms. They have a higher medical disease burden than the general population and are more likely to have a non-psychiatric hospitalization. In the hospital, these patients have an increased risk of adverse events, readmission and extended length-of-stay. Working with a Health Equity lens and the Quality Health Outcomes Model, we reviewed the literature on adverse events during medical-surgical hospitalizations for these patients and identified differences at the patient, provider and system levels between these patients and the general population. Next, a mixed methods, exploratory sequential study was conducted to: 1) explore the experience of patients with psychotic disorders hospitalized on medical-surgical unit; 2) examine patient characteristics and care processes associated with length-of-stay (primary outcome), adverse events and readmissions (secondary outcomes), among patients with psychotic disorders during non-psychiatric hospitalizations; and 3) integrate qualitative and quantitative data to contextualize factors associated with hospital outcomes among patients with psychotic disorders during non-psychiatric hospitalizations. For Phase 1, interviews were conducted with twenty patients with psychotic disorders on medical-surgical units. Five themes were developed through thematic analysis: 1) managing through hard times, 2) ignored and treated unfairly, 3) actively involved in health, 4) appreciation of caring providers and 5) violence: expected and experienced. In Phase 2, information from these interviews guided variable selection for an analysis of patient hospital records. A general linear model was conducted to examine length-of-stay’s relationship with patient characteristics and care processes. Of patient characteristics, only medical comorbidities were significantly related to length-of-stay. Certain processes of care highlighted by patients from the qualitative sample were found to be associated with length-of-stay like physical restraints (64% longer), psychiatrist consult (20% longer) and outpatient appointment in the previous six months (10% shorter). Results suggest specific patient characteristics and care processes are highly related to length-of-stay and that many of these were important to the patients in the qualitative portion. The use of mixed methods research for hospital outcomes research in this population creates valuable information for educational and clinical settings to improve care for patients with psychotic disorders.

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