The Impact of Psychiatric Diagnosis on Length of Stay in a University Medical Center in the Managed Care Era

Bourgeois, James A.; Kremen, William S.; Servis, Mark E; Wegelin, Jacob A.; Hales, Robert E.

doi:10.1176/appi.psy.46.5.431

Cited by 48 publications

(21 citation statements)

References 25 publications

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“…Co-occurring mental illness and substance abuse disorders (behavioral health problems), prevalent in 20-40% of general medical inpatients [1], are associated with longer lengths of stay (LOS) [2,3] and higher costs of care [1,2,3,4]. Bourgeois et al [4] found that co-morbid psychiatric conditions accounted for an increase of over USD 11 million in annual costs in one hospital system.…”

Section: Introductionmentioning

confidence: 99%

“…Bourgeois et al [4] found that co-morbid psychiatric conditions accounted for an increase of over USD 11 million in annual costs in one hospital system. The mechanisms of this increase in LOS are complex, ranging from the difficulty in preparing mentally ill patients for discharge or transfer due to the problems in accessing follow-along services, the complexity of treating those with mental illness [5], delays introduced by the patients' symptoms [6], simple misunderstandings between patients and care givers as well as the stigma associated with mental illness [7] to the lack of training among health-care providers to recognize mental illness [2,6,8].…”

Section: Introductionmentioning

confidence: 99%

“…The proficiency of the primary medical team may not be sufficient enough to identify the salient factors that will interfere with efficient care in a particular episode [9,10]. Furthermore, practical help may come late in the hospital stay, which may compromise its usefulness [4,10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients

Sledge

Gueorguieva

Desan

et al. 2015

Psychother Psychosom

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Background: Mental illness correlates with an increased length of stay (LOS) for patients hospitalized for medical conditions. While psychiatric consultations help manage mental illness among those hospitalized for medical conditions, consultations initiated by nonpsychiatric mental disease may lack maximum effectiveness. Methods: In a before-and-after design, in 2 contiguous years LOS for internist-initiated, conventional consultation (CC) as usual treatment was compared to LOS of a proactive, mental health professional-initiated, multidisciplinary intervention delivered by the behavioral intervention team (BIT) on the same units. The patient populations included general medical patients with a variety of illnesses. Patients were treated in 3 different inpatient settings with a total capacity of 92 beds serving 15,858 patient visits over 3 comparison years. BIT comprised a psychiatrist, a nurse, and a social worker, each of whom performed the specific tasks of their professional discipline, while collaborating among themselves and their health-care colleagues. BIT provided timely, appropriate, and effective patient care alongside consultative advice and education to their corresponding professional peers. BIT was compared to CC on the outcome of LOS. Results: There was a statistically significant reduction of LOS favoring BIT over CC for patients with an LOS of <31 days which persisted while controlling for multiple co-morbid factors. Also, a statistically significant spillover effect was suggested by the overall improvement of LOS on units implementing BIT. Conclusion: BIT is a promising means of lowering LOS on general medical units while providing a high level of care and staff support.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients

Sledge

Gueorguieva

Desan

et al. 2015

Psychother Psychosom

View full text Add to dashboard Cite

show abstract

“…Although several countries (Australia [10], Germany [11], and the UK [12]) have introduced DRG or casemix approaches, these programs could not precisely reflect the content and outcomes of psychiatric care in particular because the framework employed in the programs was too simplistic to appropriately evaluate this type of care. 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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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We evaluated psychiatric care in terms of relationships between patient characteristics and a comprehensive measurement of psychiatric outcomes among inpatients with lengths of stay (LOSs) of 90 days or fewer in a psychiatric hospital in Japan. The sample consisted of inpatients discharged from an acute care psychiatric hospital between September 1 and December 31, 2007. Multivariate analyses were performed to identify patient characteristics related to the outcome of acute psychiatric care. The type of admission was related to difference in Global Assessment of Functioning (GAF) scores (P < 0.001), health care cost (P < 0.001), length of time spent in seclusion (P < 0.001), and length of time spent in restraints (P < 0.01). Diagnosis showed a minimal or non-existent relationship to the outcome variables. The GAF scores of involuntary patients with initially low scores on this axis were greatly improved at discharge. Patients who were admitted involuntarily received more coercive interventions and treatments, such as seclusion and restraints, than did patients with who were admitted voluntarily. Diagnostic groups did not differ in terms of GAF scores. Further studies utilizing diagnostic procedure combination (DPC) data from multiple medical institutions are necessary to verify the present findings.

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“…Pattern even persisted after adjustment for DRG [1]. Since average length of stay in non long-term care facilities is generally less than 30 days [8], the study do not include observations of inpatient who stayed more than 30 days.…”

Section: Datamentioning

confidence: 99%

Length of Hospital Stay in Different Health Insurance Payment Systems

Purbaningsih¹,

Pujiyanto²,

Sari³

et al. 2018

KLS

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Before the merging of health insurance schemes in 2014, Indonesia has two type of government health insurance programs based on its payment system. Jamkesmas applied diagnosis-related groups-based (DRG) payment system, while Askes and Jamsostek are much alike to fee-for-service (FFS) model. The different payment systems likely affect hospital behavior in delivering health services. One direct measure to address this issue is hospital length of stay (LOS). This paper focuses to examine the effect of Indonesia's health insurance payment systems on hospital LOS using the Indonesia National Socio-Economic Survey (Susenas) 2012 dataset. Count data model is used to address endogeneity issue of health insurance. Our findings suggest that FFS insurance have strong effect to increase LOS, on the contrary, DRG insurance give strong effect to reduce LOS. This finding supports the idea that FFS encourages hospitals to apply more services, while DRG encourages hospitals to keep their costs low to avoid making loss.

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The Impact of Psychiatric Diagnosis on Length of Stay in a University Medical Center in the Managed Care Era

Cited by 48 publications

References 25 publications

Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients

Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients

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

Length of Hospital Stay in Different Health Insurance Payment Systems

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