Elmer A. Gardner

A Cumulative Register of Psychiatric Services in a Community

THIS IS THE first report of a longitudinal study of the interaction between an entire large American community and, for practical purposes, all parts of an extensive, highly developed network of psychiatric services which serve that community. The heart of the study is a register to which are reported contacts between psychiatric patients and the gamut of psychiatric services in the community. A general outline of the operation of the register will be given below under Method.* The project arose from the perception of the principal investigators that this particular community and the unusual network of psychiatric services in it offer an opportunity to collect simultaneously longitudinal data about persons with diagnosed mental disorders and similar data about the operation of a wide range of psychiatric services. In the past, longitudinal data about either psychiatric patients or psychiatric services have been limited to a particular type of patient or a particular type of service. Because of the broad scope of the reporting sources and the longitudinal design of the register, the data from

DEVELOPMENT OF A FLEXIBLE CONTROL SYSTEM IN THE MAINTENANCE OF A PATIENT CASE REGISTER

MUCH has been said of the possibility that, in the not too distant future, medical care will be enhanced by the maintenance of massive health record systems by high speed computers. With the use of data phones or comparable communication lines, patient information could be transferred to a central office, stored, and when necessary, fed back to the reporting sources. Thus, a summary of a patients clinical history may be rapidly available when he contacts a new medical service. Similar information retrieval systems have been developed for the accumulation of stock records, reference files, and other relatively static systems. Considerably more flexibility may be required for health record keeping, however, because of the changing nature of the data reported, the greater likelihood of inaccuracy, and the necessity for frequent revision of the stored data. This flexibility is of particular importance in the system of controls devised to assure accuracy of the recorded data. Such a control system is being developed as an integral part of a cumulative psychiatric case register operated by the University Department of Psychiatry. J This is a register of all Monroe County residents receiving psychiatric care from the facilities located within the Rochester area. Briefly, the project functions as follows: patient data are obtained from report forms which have been collected from each of the psychiatric facilities in the county since January 1960. The partially selfcoding forms are further coded in a central office for the preparation of punched cards. The data are then transferred from the cards to magnetic tape for subsequent computer processing and analysis. In the development of this case register, some of the problems involved in the maintenance and utilization of a central index of dynamic data collected from a variety of sources have been explored, and an experimental