Provider-Level Effects on Psychiatric Inpatient Length of Stay for Youth With Mental Health and Substance Abuse Disorders

Abstract

Objective: Previous research on inpatient care for children and adolescents with emotional or behavioral problems indicates that patient-level factors predict length of stay (LOS) poorly. This analysis examines whether patient-level factors are poor predictors of LOS, because LOS is primarily determined by facilities rather patients. Study Design: This study uses Tennessee Medicaid claims data from 1996 to 2001. The data include information on 14,162 observations related to 8400 patients (age 12-21) from 163 hospitals. We estimate log LOS using a cross-classified model. Covariates include admission-level characteristics (age, diagnosis, qualification for Medicaid, year), patient-level characteristics (gender, race), and facility characteristics (facility type). Principle Findings: Our results suggest that variation in LOS is attributable to facility-level factors (51%), time-invariance patientlevel factors (5%), factors that vary across admissions (42%), and a correlation between patient-level and facility-level factors (5%). Conclusions: About half of the variation in LOS is explained by facility-level factors. Given the vulnerable nature of youth who are in need of inpatient psychiatric care, it may be particularly important to monitor provider-level processes and outcomes. Measuring facility or provider level quality is complicated because of difficulties in adjusting for case-mix severity across providers. The methodology presented here represents a general framework that can be widely used in health services research. Potential applications include broadening models of utilization to simultaneously include patient, provider, geographic and community level variations, as well as provider profiling. (Med Care 2008;46: 240 -246)

Determinants of length of stay for psychiatric inpatients: Analysis of a national database covering the entire Korean elderly population

“…Even though each geropsychiatric inpatient with dementia did not stay longer than patients with other psychiatric diseases, due to progressive nature [58] and tendency to have several comorbid illnesses of dementia [59], patients admitted in an institution with the higher proportion of patients with dementia are more likely to stay longer. Although there is no previous research especially for geropsychiatric inpatients regarding contextual effects, it may be explained by provider-level effect [60,61] as well as neighborhood effect [62][63][64] in a certain medical institution. Along with it, patients admitted in the higher the proportion of "oldest old" inpatients stayed longer.…”

Length of Stay for Mental and Behavioural Disorders Postpartum in Primiparous Mothers: A Cohort Study

“…However, the mean could reflect the impact of extremely long hospital stays and is commonly used in the literature [18,21,22]. As a result we included both means and medians in the results for comparison.…”

“…Length of hospital stay was associated with facility type and diagnoses [21]. A study based on population data between 1996 and 2001 in the United States (US) showed that patients treated in mental health inpatient facilities had a significantly longer ALOS (10.5 days) than patients in general inpatient facilities (3.5 days) [21].…”

“…A study based on population data between 1996 and 2001 in the United States (US) showed that patients treated in mental health inpatient facilities had a significantly longer ALOS (10.5 days) than patients in general inpatient facilities (3.5 days) [21]. A study on substance use treatment in the US showed that the median number of days in treatment for women with substance use in pregnancy and postpartum was eight days [15].…”

County-level characteristics as predictors of dentists’ ECC counseling in the USA: a survey study

“…A number of studies from medicine have identified area-level variations in the provision of health care services [8-10]. A recent publication from dentistry examined county-level health profession workforce characteristics (i.e., percentage of female physicians, obstetricians or gynecologists, female dentists) as potential correlates of dentists’ counseling pregnant patients about prevention and periodontal disease risk [11].…”