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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

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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.

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References

  • Agency for Healthcare Research and Quality (2010). Facts and figures 2008—table 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.

  • 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 

  • 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 

  • Drake, E. R., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World Psychiatry, 11, 47–51.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • Ito, H., & Sederer, L. I. (1999). Mental health services reform in Japan. Harvard Review of Psychiatry, 7, 208–215.

    PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • Kitano, M. (2007). What’s the difference? Comparison of American and Japanese medical practice. Keio Journal of Medicine, 56, 96–101.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

  • 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.

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

  • Nishio, M. (2008). [The implementation situation concerning assertive community treatment in Japan.] Seishin Igaku [Clinical Psychiatry], 50, 1157–1164.

    Google Scholar 

  • Organisation for Economic Co-operation and Development (2010). OECD health data 2010—frequently 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.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    PubMed  CAS  Google Scholar 

  • Thornicroft, G., & Tansella, M. (2003). What are the arguments for community-based mental health care?. Copenhagen: WHO Regional Office for Europe.

    Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • Way, B. B., & Banks, S. (2001). Clinical factors related to admission and release decision in psychiatric emergency services. Psychiatric Services, 52, 214–218.

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization. (1992). The ICD-10 Classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.

    Google Scholar 

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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.

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Authors and Affiliations

  1. National Hospital Organization Higashiowari National Hospital, 2-1301, Omorikita, Moriyama-ku, Nagoya-shi, Aichi, 463-0802, Japan

    Taku Kimura & Fukashi Yagi

  2. National Hospital Organization Hizen Psychiatric Center, 160, Mitsu, Yoshinogari-cho, Kanzaki-gun, Saga, 842-0192, Japan

    Akira Yoshizumi

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  1. Taku Kimura
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  2. Fukashi Yagi
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  3. Akira Yoshizumi
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Correspondence to Taku Kimura.

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Kimura, T., Yagi, F. & Yoshizumi, A. 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. Community Ment Health J 49, 477–491 (2013). https://doi.org/10.1007/s10597-012-9562-6

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  • DOI: https://doi.org/10.1007/s10597-012-9562-6

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