Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

Abstract

BackgroundThe debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS), which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables.MethodsWe considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables). We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS.ResultsAll but two syndrome scores (mania, hostility) were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%.ConclusionsPsychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent costs. This might be considered in the development of future costing systems in psychiatry.

Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

“…While several other variables have been usually related with poor outcomes (such as unemployment, being unmarried and public insurance) 10,21 , no other studies have evaluated transient disability, a very common condition in inpatients in Brazil; our results show increased OR for transient disability in relation to employed/active status on the groups with intermediate (OR vary from 3.96 to 4.36) and poor (OR vary from 9.43 to 15.01) outcomes. Disability pension due to mental disorders has been associated with increased suicide risk 25 and heavy use of psychiatric inpatients services 26 , while this outcomes have not yet been evaluated in transient disability.…”

“…Although the LOS of psychiatric inpatients has decreased in recent decades (from months to days), it is still longer than for patients with physical illnesses, increasing expenditures on health, generating stigma and delaying social reintegration of the patient 7 . Functional ratings as the Global Assessment of Functioning (GAF) [10][11][12] and the Brief Psychiatric Rating Scale (BPRS) 13 also have been used to measure outcomes in psychiatric inpatients acutely ill, as well as the Clinical Global Impression (CGI) 14 , a measure of disease severity.…”

Patterns of utilization and outcomes of inpatient psychiatric treatment in Asian Americans.

“…In prior studies, psychiatric diagnoses have explained about 10-12% of the variance in length of stay (Phelan & McCrone, 1995), and actual psychopathological symptoms only contributed a small amount of additional variance (Warnke, Rossler, & Herwig, 2011). The relative difficulty in explaining additional variance may be indicative of the numerous clinical and psychosocial aspects that clinicians must consider when admitting and discharging a patient.…”

“…For example, rapid detoxification is likely the primary goal of inpatient treatment for patients who are presenting with substance-related problems, as with a proportion of the White American sample, warranting a shorter length of stay. On the other hand, patients whose symptoms have improved during treatment but are without sufficient outside supports may remain in the hospital until there is an adequate discharge disposition in place (Warnke et al, 2011). …”

Patient and Service-Level Factors Affecting Length of Inpatient Stay in an Acute Mental Health Service: A Retrospective Case Cohort Study

“…In order to provide this care, mental health providers need to understand what factors may have an impact on length of stay. Many studies in recent years have looked at patient factors, demographics, diagnosis and severity in order to predict length of inpatient stay, with varying and sometimes con icting results [4,5,6] .…”