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

BACKGROUND: The 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 ha...

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Autores principales: Warnke, Ingeborg, Rössler, Wulf, Herwig, Uwe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170589/
https://www.ncbi.nlm.nih.gov/pubmed/21801366
http://dx.doi.org/10.1186/1471-244X-11-120
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author Warnke, Ingeborg
Rössler, Wulf
Herwig, Uwe
author_facet Warnke, Ingeborg
Rössler, Wulf
Herwig, Uwe
author_sort Warnke, Ingeborg
collection PubMed
description BACKGROUND: The 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. METHODS: We 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. RESULTS: All 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%. CONCLUSIONS: Psychopathological 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.
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spelling pubmed-31705892011-09-11 Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services Warnke, Ingeborg Rössler, Wulf Herwig, Uwe BMC Psychiatry Research Article BACKGROUND: The 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. METHODS: We 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. RESULTS: All 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%. CONCLUSIONS: Psychopathological 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. BioMed Central 2011-07-29 /pmc/articles/PMC3170589/ /pubmed/21801366 http://dx.doi.org/10.1186/1471-244X-11-120 Text en Copyright ©2011 Warnke et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Warnke, Ingeborg
Rössler, Wulf
Herwig, Uwe
Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services
title Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services
title_full Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services
title_fullStr Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services
title_full_unstemmed Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services
title_short Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services
title_sort does psychopathology at admission predict the length of inpatient stay in psychiatry? implications for financing psychiatric services
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170589/
https://www.ncbi.nlm.nih.gov/pubmed/21801366
http://dx.doi.org/10.1186/1471-244X-11-120
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