Top

Published in:

01-08-2013 | Original Paper

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

Authors: Taku Kimura, Fukashi Yagi, Akira Yoshizumi

Published in: Community Mental Health Journal | Issue 4/2013

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.

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.

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.

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

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.PubMedCrossRef

Ito, J. (2008). [Assertive community treatment: How it works in the process of downsizing psychiatric beds?] Seishin Igaku [Clinical Psychiatry], 50, 1177–1185.

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

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.

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.PubMedCrossRef

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.PubMedCrossRef

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

Kitamura, T., Kato, G., & Sakio, E. (1997). Global assessment scale and case studies. Archives of psychiatric diagnostics and clinical evaluation, 8, 281–304.

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

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.PubMedCrossRef

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

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.PubMedCrossRef

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

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.PubMedCrossRef

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.CrossRef

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.CrossRef

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.

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.PubMedCrossRef

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.PubMedCrossRef

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.

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

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

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

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

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

Title: 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
Authors: Taku Kimura
Fukashi Yagi
Akira Yoshizumi
Publication date: 01-08-2013
Publisher: Springer US
Published in: Community Mental Health Journal / Issue 4/2013
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-012-9562-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

Barriers to Depression Treatment Among Low-Income, Latino Emergency Department Patients

Adverse Impact of Coercive Treatments on Psychiatric Inpatients’ Satisfaction with Care

Validating the NonParental Adult Inventory (NPAI) for Mental Health Assessment and Research

Factorial Structure of the Spanish Center for Epidemiologic Studies Depression Scales in HIV Patients

Combining Evidence-based Practices for Improved Behavioral Outcomes: A Demonstration Project

Course and Predictors of Physical Aggressive Behaviour after Discharge from a Psychiatric Inpatient Unit: 1 Year Follow-up