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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ABSTRACT: This qualitative study examined changes in community mental health care as described by adults diagnosed with schizophrenia with long-term involvement in the mental health system to situate their experiences within the context of mental health reform movements in the United States. A sample of 14 adults with schizophrenia who had been consumers of mental health services from 12 to 40 years completed interviews about their hospital and outpatient experiences over time and factors that contributed most to their mental health. Overall, adults noted gradual changes in mental health care over time that included higher quality of care, more humane treatment, increased partnership with providers, shorter hospital stays, and better conditions in inpatient settings. Regardless of the mental health reform era in which they were hospitalized, participants described negative hospitalization experiences resulting in considerable personal distress, powerlessness, and trauma. Adults with less than 27 years involvement in the system reported relationships with friends and family as most important to their mental health, while adults with more than 27 years involvement reported mental health services and relationships with professionals as the most important factors in their mental health. The sample did not differ in self-reported use of services during their initial and most recent hospitalization experiences, but differences were found in participants' reported use of outpatient services over time. Findings underscore the importance of the lived experience of adults with schizophrenia in grounding current discourse on mental health care reform.Psychiatric Quarterly 10/2014; · 1.26 Impact Factor
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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. · 3.50 Impact Factor
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ABSTRACT: Societal cost-of-illness in a German sample of patients with borderline personality disorder (BPD) was calculated for 12 months prior to an outpatient Dialectical Behavior Therapy (DBT) program, during a year of DBT in routine outpatient care and during a follow-up year. We retrospectively assessed resource consumption and productivity loss by means of a structured interview. Direct costs were calculated as opportunity costs and indirect costs were calculated according to the Human Capital Approach. All costs were expressed in Euros for the year 2010. Total mean annual BPD-related societal cost-of-illness was €28,026 (SD = €33,081) during pre-treatment, €18,758 (SD = €19,450) during the DBT treatment year for the 47 DBT treatment completers, and €14,750 (SD = €18,592) during the follow-up year for the 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions in inpatient treatment costs, while indirect costs barely decreased. In conclusion, our findings provide evidence that the treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Already during the DBT treatment year, these savings clearly exceed the additional treatment costs of DBT and are further extended during the follow-up year. Correspondingly, outpatient DBT has the potential to be a cost-effective treatment for BPD patients. Efforts promoting its implementation in routine care should be undertaken.Behaviour Research and Therapy 10/2014; · 3.85 Impact Factor