Advertisement

Community Mental Health Journal

, Volume 49, Issue 4, pp 477–491 | Cite as

Application of Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) to Psychiatric Practice in Japan: A Preliminary Assessment of Validity and Sensitivity to Change

  • Taku Kimura
  • Fukashi Yagi
  • Akira Yoshizumi
Original Paper

Abstract

We applied an American medical necessity scale, Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS), to psychiatric practice in Japan. This is an exploratory analysis of empirical data of 272 patients. We examined the relationships between levels of care of LOCUS and clinical variables, contribution of care levels on admission decision, and changes in care levels over time. Inpatients showed significantly higher levels of care than outpatients. Levels of care showed significant strong inverse correlations to Global Assessment Scale (GAS) scores, and significant moderate correlations to admission types, care environment, and diagnostic subgroups in almost all groups. Levels of care contributed as much to the admission decision as GAS scores. Levels of care significantly decreased from the time of admission to discharge. Our preliminary evidence indicates that LOCUS is valid and sensitive to change, and applicable for clinical use in Japan.

Keywords

LOCUS Validity Sensitivity to change Level of care Admission criteria Community-based psychiatric care 

Notes

Acknowledgments

This study was supported by a research grant (17A-1) for Nervous and Mental Disorders from the Ministry of Health, Labour and Welfare. The authors sincerely thank Wesley Sowers, M.D. and the other members of the AACP Task Force on Level of Care Determinations for their kind cooperation.

References

  1. Agency for Healthcare Research and Quality (2010). Facts and figures 2008table of contents. Healthcare Cost and Utilization Project (HCUP). Retrieved Mar 21, 2011, from Agency for Healthcare Research and Quality Web site: www.hcup-us.ahrq.gov/reports/factsandfigures/2008/TOC_2008.jsp.
  2. American Association of Community Psychiatrists. (2000). Level of care utilization system for psychiatric and addiction services, adult version 2000. Pittsburgh: American Association of Community Psychiatrists.Google Scholar
  3. American Association of Community Psychiatrists. (2009). Level of care utilization system for psychiatric and addiction services, adult version 2010. Pittsburgh: American Association of Community Psychiatrists.Google Scholar
  4. Drake, E. R., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World Psychiatry, 11, 47–51.PubMedCrossRefGoogle Scholar
  5. Glazer, W. M., & Gray, G. V. (1996). Psychometric properties of a decision-support tool for the era of managed care. Journal of Mental Health Administration, 23, 226–233.PubMedCrossRefGoogle Scholar
  6. Ito, J. (2008). [Assertive community treatment: How it works in the process of downsizing psychiatric beds?] Seishin Igaku [Clinical Psychiatry], 50, 1177–1185.Google Scholar
  7. Ito, H., & Sederer, L. I. (1999). Mental health services reform in Japan. Harvard Review of Psychiatry, 7, 208–215.PubMedGoogle Scholar
  8. Iwamoto, M., Kochi, Y., Miyazaki, S., Shibata, A., Iwao, S., Mino, K., et al. (1998). Psychiatric inpatient treatment. Japanese Journal of Psychiatric Treatment, 13, 45–71.Google Scholar
  9. Jaeschke, R., Guyatt, G. H., & Sackett, D. L. (1994a). Users’ guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Journal of the American Medical Association, 271, 389–391.PubMedCrossRefGoogle Scholar
  10. Jaeschke, R., Guyatt, G. H., & Sackett, D. L. (1994b). Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? Journal of the American Medical Association, 271, 703–707.PubMedCrossRefGoogle Scholar
  11. Kimura, T., Yagi, F., Iwanaga, H., Nakabayashi, T., & Yoshizumi, A. (2008). Practical use of a rating scale for hospitalization in psychiatric services-the inter-rater reliability of the Japanese version of level of care utilization system for psychiatric and addiction services adult version 2000 (LOCUS). Psychiatria et Neurologia Japonica, 110, 22–29.PubMedGoogle Scholar
  12. Kitamura, T., Kato, G., & Sakio, E. (1997). Global assessment scale and case studies. Archives of psychiatric diagnostics and clinical evaluation, 8, 281–304.Google Scholar
  13. Kitano, M. (2007). What’s the difference? Comparison of American and Japanese medical practice. Keio Journal of Medicine, 56, 96–101.PubMedCrossRefGoogle Scholar
  14. Lyons, J. S., Stutesman, J., Neme, J., Vessey, J., O’Manhoney, M., & Camper, J. (1997). Predicting psychiatric emergency admissions and hospital outcome. Medical Care, 35, 792–800.PubMedCrossRefGoogle Scholar
  15. Marson, D. C., McGovern, M. P., & Pomp, H. C. (1988). Psychiatric decision making in the emergency room: A research overview. American Journal of Psychiatry, 145, 918–925.PubMedGoogle Scholar
  16. Mental Health and Welfare Division of the Ministry of Health, Labour and Welfare of Japan (2010). [Records of Mental Health and Welfare in 2005]. Retrieved Mar 21, 2011, from National Center of Neurology and Psychiatry, National Institute of Mental Health, Department of Mental Health Policy and Evaluation, Visions in for Reform Research Homepage: http://www.ncnp.go.jp/nimh/keikaku/vision/data.html.
  17. Ministry of Health, Labor and Welfare of Japan (2009). [Patient Survey 2008]. Retrieved Mar 21, 2011, from the Ministry of Health, Labour and Welfare of Japan Web site: http://www.mhlw.go.jp/toukei/list/10-20.html.
  18. Ministry of Health, Labour and Welfare of Japan (2004). [Visions in Reform of Mental Health and Medical Welfare]. Retrieved Feb 23, 2010, from the Ministry of Health, Labour and Welfare of Japan Web site: http://www.mhlw.go.jp/topics/2004/09/dl/tp0902-1a.pdf.
  19. Mulder, C. L., Koopmans, G. T., & Lyons, J. S. (2005). Determinants of indicated versus actual level of care in psychiatric emergency services. Psychiatric Services, 56, 452–457.PubMedCrossRefGoogle Scholar
  20. Nishio, M. (2008). [The implementation situation concerning assertive community treatment in Japan.] Seishin Igaku [Clinical Psychiatry], 50, 1157–1164.Google Scholar
  21. Organisation for Economic Co-operation and Development (2010). OECD health data 2010frequently requested data. Retrieved Feb 14, 2011, from OECD Web site: http://www.oecd.org/document/16/0,3746,en_2649_34631_2085200_1_1_1_1,00.html.
  22. Oshima, I., Mino, Y., & Inomata, Y. (2003). Institutionalisation and schizophrenia in Japan: social environments and negative symptoms: Nationwide survey of in-patients. British Journal of Psychiatry, 183, 50–56.PubMedCrossRefGoogle Scholar
  23. Oshima, I., Mino, Y., & Inomata, Y. (2007). How many long-stay schizophrenic patients can be discharged in Japan? Psychiatry and Clinical Neuroscience, 61, 71–77.CrossRefGoogle Scholar
  24. Roy-Byrne, P., Russo, J., Rabin, L., Fuller, K., Jaffe, C., Ries, R., et al. (1998). A brief medical necessity scale for mental disorders: Reliability, validity, and clinical utility. Journal of Behavioral Health Service & Research, 25, 412–424.CrossRefGoogle Scholar
  25. Sowers, W., & Benacci, R. (2003). LOCUS training manual level of care utilization system for psychiatric and addiction services adult version 2000. Pennsylvania: Deerfield Behavioral Health, Inc.Google Scholar
  26. Sowers, W., George, C., & Thompson, K. (1999). Level of care utilization system for psychiatric and addiction services (LOCUS): A preliminary assessment of reliability and validity. Community Mental Health Journal, 35, 545–563.PubMedCrossRefGoogle Scholar
  27. Sowers, W., Pumariega, A., Huffine, C., & Fallon, T. (2003). Level-of-care decision making in behavioral health services: The LOCUS and the CALOCUS. Psychiatric Services, 54, 1461–1463.PubMedCrossRefGoogle Scholar
  28. Spaeth-Rublee, B., Pincus, H. A., Huynh, P. T., Brown, P., Rosen, A., et al. (2010). Measuring quality of mental health care: A review of initiatives and programs in selected countries. Canadian Journal of Psychiatry, 55, 539–548.Google Scholar
  29. Srebnik, D., Uehara, E., & Smukler, M. (1998). Field test of a tool for level-of-care decisions in community mental health systems. Psychiatric Services, 49, 91–97.PubMedGoogle Scholar
  30. Thornicroft, G., & Tansella, M. (2003). What are the arguments for community-based mental health care?. Copenhagen: WHO Regional Office for Europe.Google Scholar
  31. Uehara, E., Smukler, M., & Newman, F. (1994). Linking resource use to consumer level of need: Field test of the level of need-care assessment (LONCA) method. Journal of Consulting and Clinical Psychology, 62, 695–709.PubMedGoogle Scholar
  32. Way, B. B., & Banks, S. (2001). Clinical factors related to admission and release decision in psychiatric emergency services. Psychiatric Services, 52, 214–218.PubMedCrossRefGoogle Scholar
  33. World Health Organization. (1992). The ICD-10 Classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.National Hospital Organization Higashiowari National HospitalAichiJapan
  2. 2.National Hospital Organization Hizen Psychiatric CenterSagaJapan

Personalised recommendations