Development and evaluation of a case group concept for inpatients with mental disorders in Germany: Using self-report and expert-rated instruments

Abstract

The aim of this study was to evaluate a case-mix system to classify inpatients with mental disorders in Germany by means of self-report and expert-rated instruments. The use of case-mix systems enhances the transparency of performance and cost structure and can thus improve the quality of mental health care. We analysed a consecutive sample of 1677 inpatients with mental disorders from 11 hospitals using regression tree analysis. The model assigns patients to 17 groups, accounting for 17% of the variance for duration of stay. Patients with eating disorders had a longer duration of stay than patients with anxiety disorder, duration of mental illness of less than 3-5 years, lower levels of interpersonal problems and higher occupational position. The results showed that besides diagnosis, variables such as duration of illness and interpersonal problems are important for classifying inpatients with mental disorders. The results of the study should be critically reviewed regarding the empirical results of other studies and the appropriateness of case group concepts for inpatients with mental disorders.

Is the Health of the Nation Outcome Scales appropriate for the assessment of symptom severity in patients with substance-related disorders?

“…It is routinely applied in many countries (e.g., Denmark, Nova Scotia, Italy, Australia) in the treatment of patients with mental disorders (Bech et al, 2003;Kisely, Campbell, Crossman, Gleich, & Campbell, 2007;Lora et al, 2001;Trauer et al, 1999) and is gaining increasing relevance in the framework of the development of case group systems (Andreas et al, 2009;Buckingham, Burgess, Solomon, Pirkis, & Eagar, 1998;Gaines et al, 2003). In line with international developments and due to the lack of suitable national clinician-rating instruments for the differential assessment of severity, the HoNOS was translated into German with authorization from the test authors.…”

Assessment of Psychiatric Outcomes in Japan Based on Diagnostic Procedure Combination Information

“…More specifically, several studies utilizing DRGs for the prediction of LOSs reported that DRGs explained, at most, 20-30% of the variance in LOSs [14,15] and explained less than 10% of the variance on average [16][17][18]. Therefore, data in addition to LOS, including clinical information, need to be employed when using DRGs as an assessment tool for psychiatric care [14]. Previous findings related to admission type, prevalence of coercive admissions, and relationship to LOS [19][20][21] have relied on the subjective experiences of patients who experienced coercive admissions [22,23].…”

“…In the United States, DRGs were used as a weighted index for the comparison of LOSs in psychiatric and other units [13]. More specifically, several studies utilizing DRGs for the prediction of LOSs reported that DRGs explained, at most, 20-30% of the variance in LOSs [14,15] and explained less than 10% of the variance on average [16][17][18]. Therefore, data in addition to LOS, including clinical information, need to be employed when using DRGs as an assessment tool for psychiatric care [14].…”

Merkmale von funktionalen, sozialen und umweltbezogenen Bereichen im Sinne der ICF bei Patienten mit Abhängigkeitserkrankungen

“…Empirische Befunde dazu zeigen auf, dass die Auspr ä gung des Schweregrades in den aufgef ü hrten Problembereichen nur ein Merkmal zur Varianzaufkl ä rung der Behandlungsdauer. So konnten Andreas et al [31] aufzeigen, dass auch die Diagnose zu Beginn, das Alter der Patienten, die Erkrankungsdauer, die Auspr ä gung interpersoneller Probleme, Komorbidit ä ten (somatisch und psychisch), gesundheitsbezogene Lebensqualit ä t, Partnersituation und Berufsstatus der Patienten wichtige Pr ä diktoren der Behandlungsdauer in station ä rer psychosomatischer / psychotherapeutischer Rehabilitationsbehandlung sind. Auch f ü r die station ä re Rehabilitationsbehandlung Suchtkranker stellt die Auspr ä gung des Schweregrades in funktionalen, sozialen und umweltbezogenen Problembereichen nur ein Pr ä diktor des Ressourcenverbrauchs dar.…”