Anita K. Bahn

Person-matching by electronic methods

Record linkage in the updating of files is accomplished in many establishments through the use of a preassigned number, such as payroll number, customer number, or social security number. In vital and health records, however, a unique number is generally not preassigned to an individual for purposes of reporting services received to the health department. In order to determine whether different physician reports refer to the same individual, name and other identification must be compared. This is a laborious operation which is subject to various errors because of name misspellings, changes of name upon marriage, and other problems. We are interested in the maintenance of a psychiatric case register in Maryland, where many of the reports from over a hundred psychiatric agencies refer to the same patient. These records must be linked in order to provide unduplicated counts of individuals under care and longitudinal records of psychiatric history. An earlier paper [1] describes our general procedures for register maintenance by use of a digital computer (Honeywell 800). Here we present in more detail our initial procedures for the person-matching process in order to elicit comments and suggestions from persons who have had experience in matching.

An outline for community mental health research

The burgeoning interest in comprehensive community mental health service programs has intensified our awareness of the need for epidemiologic research that will add to our basic knowledge of the prevention and control of mental illness. This paper presents a conceptual framework for integrated studies of the mental health of a community. Such interlocking studies on a surveillance population should aid our understanding of etiology and provide the systematic data necessary for the evaluation of the service programs that will be established in the community.The burgeoning interest in comprehensive community mental health service programs has intensified our awareness of the need for epidemiologic research that will add to our basic knowledge of the prevention and control of mental illness. This paper presents a conceptual framework for integrated studies of the mental health of a community. Such interlocking studies on a surveillance population should aid our understanding of etiology and provide the systematic data necessary for the evaluation of the service programs that will be established in the community.

The application of life table methodology to the study of outpatient psychiatric clinic services

Abstract In contrast to previous studies where outpatient psychiatric clinic services received by terminated patients were analyzed, in this study cohorts of admitted patients are followed to provide exact answers to questions on the duration of service and the kind of service received. This is made possible by extending the general methodology of life tables, by the use of appropriate assumptions and mathematical models, to the situation where date of entrance and date of departure of cohort members are reported in calendar months only. The methodology utilizes all available data by incorporating the experience of persons with short observation period. The duration of clinic stay is compared for a large number of patient characteristics. The cohort approach applied to the study of services and disposition provides an indication of the trend in these variables by duration of clinic experience. These findings are contrasted for two patient cohorts—children and adults. In general the data suggest that for many patients, clinic service is brief. Two major reasons accounting for this brevity of service are: (1) the clinic, to a large extent, serves as a diagnostic and referral agency, (2) a large proportion of patients, particularly adults, withdraw from service on their own initiative. Further studies to explore these and other aspects of the data are now under way.

Experience and philosophy with regard to case registers in health and welfare

A well designed and executed case register for mental illness or other conditions can provide information not readily obtainable by any other method. This includes unduplicated counts of diagnosed cases of the disease and longitudinal information such as changes in diagnosis, outcome, and survival information. Registers often are the only way in which “new” cases can be identified with any certainty. Also, the register can serve as a sampling frame for more intensive studies of services and of prevalence of the disease in the community, genetic studies, studies of the cost of treating various types of patients, “before” and “after” comparisons, and many other sociological and epidemiologic investigations. At the same time, there are many problems and pitfalls to case registers. This paper outlines some of these difficulties and suggests that registers be established only after careful planning and preparation.A well designed and executed case register for mental illness or other conditions can provide information not readily obtainable by any other method. This includes unduplicated counts of diagnosed cases of the disease and longitudinal information such as changes in diagnosis, outcome, and survival information. Registers often are the only way in which “new” cases can be identified with any certainty. Also, the register can serve as a sampling frame for more intensive studies of services and of prevalence of the disease in the community, genetic studies, studies of the cost of treating various types of patients, “before” and “after” comparisons, and many other sociological and epidemiologic investigations. At the same time, there are many problems and pitfalls to case registers. This paper outlines some of these difficulties and suggests that registers be established only after careful planning and preparation.

Diagnostic Characteristics Related to Services in Psychiatric Clinics for Children

Tr _HE standard diagnostic nomenclature of mental disorders (1) has been applied to children since the initiation in 1954 of nationwide psychiatric clinic reporting (2). Much criticism has been evoked and numerous difficulties cited in the application of these standard classifications to children (3) (4). We have encountered a number of such problems but even with these limitations have been able to demonstrate large differences in the risk of clinic admission by diagnosis and by population groups (5). In this paper, we should like to consider a corollary issue: to what extent is the psychiatric classification an operationally important variable in determining the course of clinic service for the child patient? We shall use data from one state (Maryland) where an intensive educational effort with clinic professional and clerical personnel preceded and accompanied the collection of reports. Maryland is an eastern seaboard state of 10,000 square miles and three million population; its large urban center, Baltimore City, has approximately one million people. Four Maryland counties met the 1950 census definition of a metropolitan area-Baltimore and Anne Arundel counties, which are contiguous with Baltimore City, and Montgomery and Prince Georges counties, adjacent to Washington, D.C. About a fourth of the population was classified as rural in the 1950

Data utilization for local mental health program development

The importance of data collection and utilization for program development on the local level is emphasized, and a systematic approach to data collection for planning and evaluation of local mental health services is outlined. Examples of local programs in which such information has been employed are cited. Recommendations are made to facilitate the local planning function.