Identifying patterns in psychiatric hospital stays with statistical methods: towards a typology of post-deinstitutionalization hospitalization trajectories

Abstract

Over the past fifty years, deinstitutionalization changed the face of psychiatry. However, outpatient treatment in the community does not always fit the needs of those who left institutions and sometimes leads to frequent re-hospitalizations, a mechanism known as the "revolving door" phenomenon. The study aim was to identify different typologies of hospitalization trajectories. Methods: Records of 892 inpatients from the Department of Psychiatry of Lausanne UniversityHospital were analysed over a three-year period with discrete sequential-state analysis.Results: Trajectories could be split between atypical users (4.9% of patients totalling 30.6% of hospital days) and regular users. Within the atypical users group, three categories were identified:"Permanent stays" (3 patients totalling 6.3% of hospital days), "long stays" (1.7% patients / 8.6% hospital days) and "revolving door" stays (2.9% patients / 15.8% hospital days). The remaining 95.1% of the patients were classified into "unique episodes" (70.0% patients / 24.5% hospital days) and "repeated episodes" (25.0% patients / 44.9% hospital days). Diagnoses of schizophrenia were overrepresented among heavy users. Conclusions:Most patients went through a unique or low number of brief hospital admissions over the three years of the study. While the shift of previously institutionalized individuals towards high users of psychiatric hospital seems limited, this phenomenon should not be neglected since 4.9% of patients use about a third of hospital beds. Early identification of problematic profiles could allow the implementation of relapse prevention strategies and facilitate the development of alternatives to hospitalization such as assertive community treatment or housing first programs.

Pattern of inpatient care for depression: an analysis of 232,289 admissions

“…In contrast to unipolar depressed patients, LOS in bipolar depression was found to be shorter in women [40]. At first glance, these results appear counter-intuitive, a closer look points at the possibility that a large part of female admissions might be due to readmissions of a relatively small subgroup as described earlier in literature [39,41].…”

“…This is in line with a well documented gender difference in health seeking behaviour [ 37 , 38 ]. Seen as a whole, in times of growing economic pressure and a limited number of hospital beds available, there is a danger that men are discharged too early because of a reluctance of reporting symptoms compared to women conceivably leading to early readmissions and a so-called revolving door effect [ 39 ].…”

Recovering the Capacity to Live outside of a Psychiatric Hospital: Impact of a Specialized Inpatient Program

“…However, this issue of long stays or frequent readmission recently received more attention. A study, conducted in our catchment area revealed that a only a small minority of patients met this profile (4.9% of all admissions) while they used a third of our hospital beds [5]. They were mostly middle aged (45 years) with an overrepresentation of females and the majority presented either with schizophrenia, personality disorders substance use disorder, or combinations of these.…”

Articulação do cuidado a crianças e adolescentes usuários de drogas: estudo de caso em uma Unidade de Acolhimento

“…Ainda assim, estamos presenciando ações contraditórias, higienistas e eugenistas como as internações compulsórias de crianças e adolescentes em situação de rua e usuários de drogas, indo contra diretrizes dignas e democráticas, e mesmo o ECA e a Lei nº 10.216 (Passos et al, 2016). Ainda sendo necessários esforços para avançar em direção a uma sociedade que melhor tolera e integra os sem-teto, os pacientes que abandonam cuidados ou recusam cuidados e outros que vivem à margem da sociedade (Golay et al, 2019).…”

“…O fenômeno de porta giratória -"revolving door"foi assim denominado no campo da psiquiatria e refere-se às frequentes re-hospitalizações de pacientes psiquiátricos. No contexto (pós)(des)institucionalização, torna-se importante identificar subgrupos de pacientes afetados por esse fenômeno (Golay, Morandi, Conus & Bonsack, 2019)…”