The Journal of Behavioral Health Services & Research

, Volume 25, Issue 4, pp 412–424

A brief medical neccssity scale for mental disorders: Reliability, validity, and clinical utility

  • Peter Roy-Byrne
  • Joan Russo
  • Leora Rabin
  • Karen Fuller
  • Craig Jaffe
  • Richard Ries
  • Christos Dagadakis
  • David Avery
Articles

Abstract

Managed care organizations (MCOs) use the concept of “medical necessity” to decide whether a prescribed treatment is warranted for a given medical condition. Because mental disorders lack the objective disease criteria common to medical illness, behavioral health administrators need a validated means to identify and quantify the severity of “medically important” aspects of mental disorders. The authors developed and tested a brief medical necessity scale for mental disorders in 205 patients presenting for initial evaluation. The scale had a factor structure with four subscales; good internal consistency, interrater reliability, and concurrent and predictive validity; and modest ability to identify patients requiring hospitalization and, in hospitalized patients, those requiring involuntary hospitalization. The authors propose use of the scale to better clarify decisions about level of care assignments and to better assess patient characteristics predictive of good outcome.

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References

  1. 1.
    Glazer WM, Kramer R, Montgomery JS, et al.: Use of medical necessity scales in concurrent review of psychiatric inpatient care.Hospital and Community Psychiatry 1991; 42:188–200.Google Scholar
  2. 2.
    Glazer WM, Kramer R, Montgomery JS, et al.: Medical necessity scales for inpatient psychiatric concurrent review.Hospital and Community Psychiatry 1992; 43:935–937.Google Scholar
  3. 3.
    Bergthold LA: Medical necessity: Do we need it?Health Affairs 1955; 14(4):180–190.Google Scholar
  4. 4.
    Nyman G, Harbin H, Book J, et al.: Green Spring criteria for medical necessity of outpatient treatment and its use in a mental utilization review program.Quality Assurance Utilization Review 1922; 7(2):65–69.Google Scholar
  5. 5.
    Mendel W, Rapport S: Determinants of the decision for psychiatric hospitalization.Archives of General Psychiatry 1969; 20:321–328.Google Scholar
  6. 6.
    Bengelsdorf H, Levy LG, Emerson RL, et al.: A crisis triage rating scale.Joural of Nervous and Mental Disease 1984; 172:424–430.Google Scholar
  7. 7.
    Flynn HR, Henisz JE: Criteria for psychiatric hospitalization: Experience with a checklist for chart review.American Journal of Psychiatry 1975; 132:847–850.Google Scholar
  8. 8.
    Henisz JE, Etkin K, Levine MS: Criteria for psychiatric hospitalization: A checklist approach.Behavior Research Methods and Instrumentation 1981; 13:629–636.Google Scholar
  9. 9.
    Newmark CS, Gentry L, Goodman M: Validation of criteria for psychiatric hospitalization checklist.Journal of Clinical Psychology 1977; 33:156–159.Google Scholar
  10. 10.
    Rose S, Hawkins J, Apodaca L, et al.: Decision to admit.Archives of General Psychiatry 1977; 34:418–421.Google Scholar
  11. 11.
    Warner SL: Criteria for involuntary hospitalization of psychiatric patients in a public hospital.Mental Hygiene 1961; 45:122–128.Google Scholar
  12. 12.
    Zohar M, Hadas Z, Modan B: Factors affecting the decision to admit mental patients in a community hospital.Journal of Nervous and Mental Disease 1987; 175:301–305.Google Scholar
  13. 13.
    Dickey B, Azeni H: Persons with dual diagnoses of substance abuse and major mental illness: Their excess costs of psychiatric care.American Journal of Public Health 1996; 68:973–977.Google Scholar
  14. 14.
    Roy-Byrne P, Dagadakis C, Ries R, et al.: A psychiatrist-rated battery of measures for assessing the clinical status of psychiatric inpatients.Psychiatric Services 1995; 46:347–352.Google Scholar
  15. 15.
    Goldman HH, Skodol AE, Lave TR: Revising Axis V for DSM-IV: A review of measures of social functioning.American Journal of Psychiatry 1992; 49:1148–1161.Google Scholar
  16. 16.
    Crum RS, Anthony JC, Basset SS, et al.: Population-based norms for the Mini Mental State Examination by age and education level.Journal of the American Medical Association 1993; 269:2386–2391.Google Scholar
  17. 17.
    Bigelow LB, Berthot BD: The Psychiatric Symptom Assessment Scale.Psychopharmacology Bulletin 1989; 25:168–170.Google Scholar
  18. 18.
    American Society of Addiction Medicine:Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders. Chevy Chase, MD: ASAM, 1994.Google Scholar
  19. 19.
    Ward J, Dow M:FARS: Functional Assessment Rating Scale. Tampa: University of South Florida, Florida Mental Health Institute, Department of Community Mental Health, 1995–1996.Google Scholar
  20. 20.
    Amerian Association of Community Psychiatrists:LOCUS: Level of care utilization system for psychiatric and addiction services, adult Version 1.1. Pittsburgh, PA: AACP, 1996.Google Scholar
  21. 21.
    Smukler M, Sherman PS, Srebnik DS, et al.: Developing local service standards for managed mental health services.Administration and Policy in Mental Health 1996; 24:101–116.Google Scholar
  22. 22.
    Srebnik D, Vehara E, Smukler M: Field test of a tool for level of care decisions in community mental health systems.Psychiatric Services 1998; 49:91–97.Google Scholar
  23. 23.
    Regier DA, Farmer ME, Rae DS, et al.: Comorbidity of mental disorders with alcohol and other drug abuse.Journal of the American Medical Association 1990; 264:2511–2518.Google Scholar
  24. 24.
    Pages KP, Russo JE, Roy-Byrne PP, et al.: Determinants of suicidal ideation: The role of substance use disorders.Journal of Clinical Psychiatry 1997; 58:510–515.Google Scholar

Copyright information

© Association of Behavioral Healthcare Management 1998

Authors and Affiliations

  • Peter Roy-Byrne
    • 1
  • Joan Russo
    • 1
  • Leora Rabin
    • 1
  • Karen Fuller
    • 1
  • Craig Jaffe
    • 1
  • Richard Ries
    • 1
  • Christos Dagadakis
    • 1
  • David Avery
    • 1
  1. 1.Harborview Medical CenterUniversity of WashingtonSeattle

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