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      Ranking important predictors of the need for a high-acuity psychiatry unit among 2,064 inpatients admitted to psychiatric emergency hospitals: a random forest model

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          Abstract

          Aims

          In order to uphold and enhance the emergency psychiatric care system, a thorough comprehension of the characteristics of patients who require a high-acuity psychiatry unit is indispensable. We aimed to clarify the most important predictors of the need for a high-acuity psychiatry unit using a random forest model.

          Methods

          This cross-sectional study encompassed patients admitted to psychiatric emergency hospitals at 161 medical institutions across Japan between December 8, 2022, and January 31, 2023. Questionnaires were completed by psychiatrists, with a maximum of 30 patients assessed per medical institution. The questionnaires included psychiatrists’ assessment of the patient’s condition (exposure variables) and the need for a high-acuity psychiatry unit (outcome variables). The exposure variables consisted of 32 binary variables, including age, diagnoses, and clinical condition (i.e., factors on the clinical profile, emergency treatment requirements, and purpose of hospitalization). The outcome variable was the need for a high-acuity psychiatry unit, scored from 0 to 10. To identify the most important predictors of the need for a high-acuity psychiatry unit, we used a random forest model. As a sensitivity analysis, multivariate linear regression analysis was performed.

          Results

          Data on 2,164 patients from 81 medical institutions were obtained (response rate, 50.3%). After excluding participants with missing values, this analysis included 2,064 patients. Of the 32 items, the top-5 predictors of the need for a high-acuity psychiatry unit were the essentiality of inpatient treatment (otherwise, symptoms will worsen or linger), need for 24-hour professional care, symptom severity, safety ensured by specialized equipment, and medication management. These items were each significantly and positively associated with the need for a high-acuity psychiatry unit in linear regression analyses (p < 0.001 for all). Conversely, items on age and diagnosis were lower in the ranking and were not statistically significant in linear regression models.

          Conclusion

          Items related to the patient’s clinical profile might hold greater importance in predicting the need for a high-acuity psychiatry unit than do items associated with age and diagnosis.

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          Most cited references24

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          Random Forests

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            Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US

            This cross-sectional study examines trends in emergency department visits and visits that led to hospitalizations during a 4-month period leading up to and during the COVID-19 outbreak in the US.
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              Response rates to mail surveys published in medical journals.

              The purpose of this study was to characterize response rates for mail surveys published in medical journals; to determine how the response rate among subjects who are typical targets of mail surveys varies; and to evaluate the contribution of several techniques used by investigators to enhance response rates. One hundred seventy-eight manuscripts published in 1991, representing 321 distinct mail surveys, were abstracted to determine response rates and survey techniques. In a follow-up mail survey, 113 authors of these manuscripts provided supplementary information. The mean response rate among mail surveys published in medical journals is approximately 60%. However, response rates vary according to subject studied and techniques used. Published surveys of physicians have a mean response rate of only 54%, and those of non-physicians have a mean response rate of 68%. In addition, multivariable models suggest that written reminders provided with a copy of the instrument and telephone reminders are each associated with response rates about 13% higher than surveys that do not use these techniques. Other techniques, such as anonymity and financial incentives, are not associated with higher response rates. Although several mail survey techniques are associated with higher response rates, response rates to published mail surveys tend to be moderate. However, a survey's response rate is at best an indirect indication of the extent of non-respondent bias. Investigators, journal editors, and readers should devote more attention to assessments of bias, and less to specific response rate thresholds.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/1124434Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/715515Role: Role: Role: Role: Role:
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                URI : https://loop.frontiersin.org/people/1311951Role: Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/2644015Role: Role: Role: Role: Role: Role:
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                08 February 2024
                2024
                : 15
                : 1303189
                Affiliations
                [1] 1 Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo, Japan
                [2] 2 Department of Psychiatry, National Hospital Organization Kumamoto Medical Center , Kumamoto, Japan
                [3] 3 Chiba Psychiatric Medical Center , Chiba, Japan
                [4] 4 Yamaguchi Prefectural Mental Health Medical Center , Yamaguchi, Japan
                [5] 5 Okehazama Hospital Fujita Kokoro Care Center , Toyoake-shi, Japan
                [6] 6 Department of Psychiatry, Okayama Psychiatric Medical Center , Okayama, Japan
                [7] 7 Numazu Chuo Hospital , Numazu, Japan
                Author notes

                Edited by: Renato de Filippis, University Magna Graecia of Catanzaro, Italy

                Reviewed by: Urska Arnautovska, The University of Queensland, Australia

                Chengcheng Han, Xi’an Jiaotong University, China

                Peiyuan Tian, Xi’an Jiaotong University, China, in collaboration with reviewer CH

                *Correspondence: Mai Iwanaga, maiiwanaga@ 123456ncnp.go.jp
                Article
                10.3389/fpsyt.2024.1303189
                10882085
                38389987
                3b63620a-4705-4447-9b75-82478847d98d
                Copyright © 2024 Iwanaga, Yamaguchi, Hashimoto, Hanaoka, Kaneyuki, Fujita, Kishi, Hirata, Fujii and Sugiyama

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 27 September 2023
                : 22 January 2024
                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 26, Pages: 9, Words: 4834
                Funding
                Funded by: Ministry of Health, Labour and Welfare , doi 10.13039/501100003478;
                Award ID: 22GC2003
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Grant to CF: Policy research to promote the establishment of a community-based comprehensive care system focusing on mental disorders (22GC2003).
                Categories
                Psychiatry
                Original Research
                Custom metadata
                Social Psychiatry and Psychiatric Rehabilitation

                Clinical Psychology & Psychiatry
                acute,decision-making,emergency,hospitalization,inpatient,predictor
                Clinical Psychology & Psychiatry
                acute, decision-making, emergency, hospitalization, inpatient, predictor

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