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

BMC Psychiatry

Research Article

Wulf Rössler¹  Ingeborg Warnke¹  Uwe Herwig¹ 

[1] Department of General and Social Psychiatry, Psychiatric University Hospital, Zurich, Switzerland;

关键词: Psychiatric Hospital;    Psychopathological Symptom;    Crisis Intervention;    Depressive Syndrome;    Multivariate Statistical Model;   

DOI  :  10.1186/1471-244X-11-120

 received in 2010-12-23, accepted in 2011-07-29,  发布年份 2011

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Warnke et al; licensee BioMed Central Ltd. 2011