Inpatients’ assessment of outcome at psychiatric institutions: an analysis of predictors following a national cross-sectional survey in Norway

OBJECTIVES: The objective was to assess the importance of different types of predictors for patient-reported outcome, both background factors at the patient level and healthcare predictors related to structure and processes of healthcare. DESIGN: Cross-sectional patient experience survey. SETTING: All 280 secondary care institutions in Norway providing inpatient care for adult psychiatric patients. PARTICIPANTS: 1683 inpatients responded to the questionnaire on-site (73.4%). PRIMARY OUTCOME MEASURES: The outcome scale of the Psychiatric Inpatient Patient Experience Questionnaire–On-Site was the primary dependent variable. The scale consists of five items relating to overall patient satisfaction, benefit of treatment and patient enablement. Regressions were used to assess predictors, for all patients and for five different patient groups reported by the patients including anxiety/depression, drug-related problems and eating disorders. RESULTS: Multilevel linear regression for all patients showed that background factors related to overall current state, self-perceived mental health before admission and admission type were the most important predictors for patient-assessed outcome. Poor current state was associated with poor assessment of outcome (estimate: 8.64, p<0.001), poor health before admission was associated with better outcome (estimate: −6.89, p<0.001) and patients with urgent admission had poorer scores on the outcome scale (estimate: 4.40, p<0.001). A range of structure and healthcare variables were related to patient-assessed outcome, the most important being clinicians/personnel understanding your situation, treatment adjusted to your situation and adequate information about mental health condition. CONCLUSIONS: Self-perceived mental health before admission, current overall state and type of admission were the most important background factors for patient-assessed outcome. The most important structure and process variables were related to patient-centred interaction. The background factors should be considered in case-mix adjustments of quality indicators, while the process variables could be used as focus areas in work aiming to improve patients’ assessment of outcome.