Length of Inpatient Stay of Persons With Serious Mental Illness: Effects of Hospital and Regional Characteristics
ABSTRACT This study examined the extent to which hospital and regional characteristics are associated with length of hospitalization among patients with serious mental illness.
Data from the Pennsylvania Health Care Cost Containment Council and 2006 American Hospital Association data were obtained. The sample consisted of 106 hospitals from which 45,497 adults with serious mental illness were discharged in 2006. Guided by the extended version of Andersen's health care utilization model, hierarchical linear modeling, including patient case mix, hospital, and regional characteristics, was used to explain variations in hospitalization length.
The average length of stay was 10.0±3.0 days. Stays were longer at psychiatric hospitals than at general acute care facilities and at hospitals with a greater percentage of Medicare patients and patients with serious mental illness and a higher rate of readmission. In terms of regional characteristics, stays were also longer at hospitals in counties where the county mental health program received a larger percentage of the state's mental health budget and a smaller share of the budget was used for residential care.
Hospital type and case mix, along with the presence of housing resources funded by county mental health programs, were found to be associated with variations in length of hospitalization. Further research of a longitudinal or prospective nature is required to determine whether the availability of housing programs for persons with mental disorders leads to shorter hospital stays for those in crisis and to determine whether longer stays are the result of differences in hospital practices. (Psychiatric Services 63:889-895, 2012; doi: 10.1176/appi.ps.201100412).
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- "First, previous reports were based almost exclusively on use of mobile devices as part of research studies, typically over a 6-days period. While, the average length of hospitalization of patients with serious mental illness is only slightly longer (10 days; Lee et al., 2012), the feasibility and clinical utility of such devices as part of regular clinical inpatient treatment needs to be evaluated and confirmed. Second, in order to implement the use of mobile devices as part of regular clinical care and make the most out the rich data collected, a centralized data analyses system needs to be developed. "
ABSTRACT: Mobile electronic devices (i.e., PDAs, cellphones) have been used successfully as part of research studies of individuals with severe mental illness living in the community. More recently, efforts have been made to incorporate such technologies into outpatient treatments. However, few attempts have been made to date to employ such mobile devices among hospitalized psychiatric patients. In this article, we evaluate the potential use of such devices in inpatient psychiatric settings using thirty-three hospitalized patients with schizophrenia. Employing an Experience Sampling Method approach, we provide support for the feasibility of using such devices, along with examples of potentially clinically-relevant information that can be obtained using such technologies, including assessment of fluctuations in the severity of psychotic symptoms and negative mood in relation to social context, unit location, and time of day. Following these examples, we discuss issues related to the potential use of mobile electronic devices by patients hospitalized at inpatient psychiatric settings including issues related to patients’ compliance, assessment schedules, questionnaire development, confidentiality issues, as well as selection of appropriate software/hardware. Finally, we delineate some issues and areas of inquiry requiring additional research and development.Asian Journal of Psychiatry 08/2014; 10:90-95. DOI:10.1016/j.ajp.2014.04.004
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ABSTRACT: The functions and nature of inpatient psychiatric units have changed dramatically over recent decades, as has the role of psychiatric residents on these units. Nonetheless, clinical rotations on inpatient psychiatry remain as core clinical experiences in psychiatric residency. This column reviews the key changes in the residents' inpatient experience and articulates appropriate educational goals for current inpatient rotations in the areas of the psychiatric interview, diagnosis and formulation, treatment planning, working as a member of a multidisciplinary team, and working with acutely ill and involuntary patients.Harvard Review of Psychiatry 01/2014; 22(3):201-4. DOI:10.1097/HRP.0000000000000037 · 2.49 Impact Factor
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ABSTRACT: Criteria for psychiatric hospitalization have undergone marked changes. Efforts to limit length-of-hospitalization risk greater morbidity at discharge and increased needs for appropriate aftercare. Accordingly, we evaluated factors associated with length of psychiatric hospitalization and aftercare-types. We reviewed medical records of 589 patients with major psychiatric disorders hospitalized in a university-affiliated, not-for-profit psychiatric hospital to identify characteristics associated with length of hospitalization, types of aftercare and insurance coverage, using standard bivariate and multivariate analytical methods. Notable factors associated with longer hospitalization included: more highly supervised aftercare, diagnosis of schizophrenia or schizoaffective>affective disorders, longer illnesses, higher antipsychotic doses and more complex drug-treatments at discharge, lower GAF functional status, unemployment, being unmarried, as well as public vs. private insurance. Multivariate modeling sustained association of longer hospitalization with higher antipsychotic doses, more structured aftercare, public insurance, lower GAF scores, and diagnoses of chronic psychotic disorders. Structured aftercare was associated with younger age, fewer years ill, and private insurance, but varied little by diagnosis and was unrelated to ethnicity. Public insurance was associated notably with being unemployed, unmarried, less functional, having a chronic psychotic disorder for more years, and lack of structured aftercare. Illness severity and functional impairment may modulate efforts to limit psychiatric hospitalization. Higher-level aftercare was associated with illness and disability factors as well as with private insurance; public insurance was associated with dysfunction, unemployment and chronic illness, as well as longer hospitalization.Comprehensive psychiatry 11/2013; 55. DOI:10.1016/j.comppsych.2013.11.004 · 2.26 Impact Factor