Religion index for psychiatric research

In a project conducted at the Medical Center of Central Massachusetts, in conjunction with the Massachusetts Department of Mental Health, board-certified psychiatrists interviewed patients over a video link regarding suicidal ideation, imminent suicidal intent, homicidal ideation or intent, active delusions, hallucinations, or gross impairment of judgment.Ratings on multiple scales, which culminated in determination of the need for involuntary commitment, were independently completed by a psychiatrist in the room with the patient and the interviewer at the remote telemedicine site.In 12 evaluations, the mean weighted kappa coefficient for the two raters on the eight clinical scales was 0.85 (F=20.85,df=95, 95, p<0.001).According to the criteria of Landis and Koch (3), this result indicates "very good" agreement between raters.For determining the need for involuntary commitment, there was perfect agreement between raters (kappa= 1.00); 50% of the patients met the Massachusetts commitment criteria.After the evaluations, the "in room" psychiatrist conferred with the telepsychiatrist regarding additional information that might have been observed directly but missed by the video link; in none of the 12 evaluations was such an omission noted.On the basis of this experience and the ongoing monitoring of telemedicine evaluations by videotaping (with patient consent), we have established a system for the telemedicine evaluation of patients at multiple participating facilities.We believe this model both improves the quality of emergency care available to satellite facilities and greatly reduces the cost of this critical service.