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Research article
Does High and Intensive Care Reduce Coercion? Association of Hic Model Fidelity to Seclusion Use in the Netherlands
A.L. van Melle
VU medisch centrum
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3173-1354
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Psychiatry.
Background
A new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcareand to reduce coercion.
Methods
In 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics.
Results
Results showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207).The HIC model fidelity scores explained 27% of the variance in seclusion rates (p< 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%.
Conclusions
This study showed that higher HIC modelfidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.
Keywords
Seclusion, coercion, model fidelity, psychiatry, High and Intensive Care (HIC)
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CURRENT STATUS: Published
Version 1
Posted 22 May, 2020
Published
On 29 Sep, 2020
Published
On 29 Sep, 2020
Published
On 29 Sep, 2020
No community comments so far
Editorial decision: Accept
On 03 Sep, 2020
Reviewer #3 agreed
On 07 Aug, 2020
Review #3 received
Received 07 Aug, 2020
Reviewer #2 agreed
On 28 Jul, 2020
Review #2 received
Received 28 Jul, 2020
Review #1 received
Received 26 Jul, 2020
Reviewer #1 agreed
On 21 Jul, 2020
Reviewers invited
Invitations sent on 11 Jun, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 08 May, 2020
Metrics
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Subject Areas
Psychiatry
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This preprint is under consideration at BMC Psychiatry. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Does High and Intensive Care Reduce Coercion? Association of Hic Model Fidelity to Seclusion Use in the Netherlands
A.L. van Melle
VU medisch centrum
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3173-1354
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 22 May, 2020
Published
On 29 Sep, 2020
Published
On 29 Sep, 2020
Published
On 29 Sep, 2020
No community comments so far
Editorial decision: Accept
On 03 Sep, 2020
Reviewer #3 agreed
On 07 Aug, 2020
Review #3 received
Received 07 Aug, 2020
Reviewer #2 agreed
On 28 Jul, 2020
Review #2 received
Received 28 Jul, 2020
Review #1 received
Received 26 Jul, 2020
Reviewer #1 agreed
On 21 Jul, 2020
Reviewers invited
Invitations sent on 11 Jun, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 08 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Psychiatry
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Psychiatry.
Background
A new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcareand to reduce coercion.
Methods
In 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics.
Results
Results showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207).The HIC model fidelity scores explained 27% of the variance in seclusion rates (p< 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%.
Conclusions
This study showed that higher HIC modelfidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.