Psychosomatics 40:345-355, August 1999
© 1999 The Academy of Psychosomatic Medine
Integrating Medical and Psychiatric Treatment in an Inpatient Medical Setting
The Type IV Program
Yasuhiro Kishi, M.D., and
Roger G. Kathol, M.D.
Received June 16, 1998; revised November 4, 1998; accepted December 4, 1998. From the Department of Psychiatry, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan; and the Departments of Psychiatry and Internal Medicine, University of Iowa Hospitals, Iowa City, Iowa. Address correspondence and reprint requests to Dr. Kathol, Departments of Psychiatry and Internal Medicine, University of Iowa Hospitals, C429–GH1, 200 Hawkins Drive, Iowa City, IA 52242; e-mail: cartsolu{at}tutti.inav.net
This study compares the treatment of patients with comorbid medical and psychiatric illness admitted to a high-acuity (Type IV) integrated medicine and psychiatry inpatient program with patients having psychiatric symptoms on general internal medicine wards (IMWs). More patients in the Type IV program had agitation, suicidal ideation, or psychosis as psychiatric admissionbehaviors when compared to IMW patients. Medical symptom improvement was comparable in the two settings, whereas, psychiatric symptoms improved more in the Type IV Program than on the IMWs despite more significant illness and comparable lengths of stay. Integrated care on the Type IV unit allowed shorter total lengths of stay for medical patients with serious psychiatric illness than would have occurred had the traditional sequential approach to care been used. The integrated Type IV medicine and psychiatry treatment program represents an efficient and effective process improvement in the way that medical patients with comorbid medical and psychiatric illness can be treated.
Key Words: Inpatients • Medical Psychiatry • Consultation Psychiatry
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