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Determinants of per diem Hospital Costs in Mental Health

INTRODUCTION: An understanding of differences in hospital costs between patient groups is relevant for the efficient organisation of inpatient care. The main aim of this study was to confirm the hypothesis that eight a priori identified cost drivers influence per diem hospital costs. A second aim wa...

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Autores principales: Wolff, Jan, McCrone, Paul, Patel, Anita, Normann, Claus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816317/
https://www.ncbi.nlm.nih.gov/pubmed/27031955
http://dx.doi.org/10.1371/journal.pone.0152669
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author Wolff, Jan
McCrone, Paul
Patel, Anita
Normann, Claus
author_facet Wolff, Jan
McCrone, Paul
Patel, Anita
Normann, Claus
author_sort Wolff, Jan
collection PubMed
description INTRODUCTION: An understanding of differences in hospital costs between patient groups is relevant for the efficient organisation of inpatient care. The main aim of this study was to confirm the hypothesis that eight a priori identified cost drivers influence per diem hospital costs. A second aim was to explore further variables that might influence hospital costs. METHODS: The study included 667 inpatient episodes consecutively discharged in 2014 at the psychiatric hospital of the Medical Centre- University of Freiburg. Fifty-one patient characteristics were analysed. Per diem costs were calculated from the hospital perspective based on a detailed documentation of resource use. Mixed-effects maximum likelihood regression and an ensemble of conditional inference trees were used to analyse data. RESULTS: The study confirmed the a priori hypothesis that not being of middle age (33–64 years), danger to self, involuntary admission, problems in the activities of daily living, the presence of delusional symptoms, the presence of affective symptoms, short length of stay and the discharging ward affect per diem hospital costs. A patient classification system for prospective per diem payment was suggested with the highest per diem hospital costs in episodes having both delusional symptoms and involuntary admissions and the lowest hospital costs in episodes having neither delusional symptoms nor somatic comorbidities. CONCLUSION: Although reliable cost drivers were identified, idiosyncrasies of mental health care complicated the identification of clear and consistent differences in hospital costs between patient groups. Further research could greatly inform current discussions about inpatient mental health reimbursement, in particular with multicentre studies that might find algorithms to split patients in more resource-homogeneous groups.
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spelling pubmed-48163172016-04-14 Determinants of per diem Hospital Costs in Mental Health Wolff, Jan McCrone, Paul Patel, Anita Normann, Claus PLoS One Research Article INTRODUCTION: An understanding of differences in hospital costs between patient groups is relevant for the efficient organisation of inpatient care. The main aim of this study was to confirm the hypothesis that eight a priori identified cost drivers influence per diem hospital costs. A second aim was to explore further variables that might influence hospital costs. METHODS: The study included 667 inpatient episodes consecutively discharged in 2014 at the psychiatric hospital of the Medical Centre- University of Freiburg. Fifty-one patient characteristics were analysed. Per diem costs were calculated from the hospital perspective based on a detailed documentation of resource use. Mixed-effects maximum likelihood regression and an ensemble of conditional inference trees were used to analyse data. RESULTS: The study confirmed the a priori hypothesis that not being of middle age (33–64 years), danger to self, involuntary admission, problems in the activities of daily living, the presence of delusional symptoms, the presence of affective symptoms, short length of stay and the discharging ward affect per diem hospital costs. A patient classification system for prospective per diem payment was suggested with the highest per diem hospital costs in episodes having both delusional symptoms and involuntary admissions and the lowest hospital costs in episodes having neither delusional symptoms nor somatic comorbidities. CONCLUSION: Although reliable cost drivers were identified, idiosyncrasies of mental health care complicated the identification of clear and consistent differences in hospital costs between patient groups. Further research could greatly inform current discussions about inpatient mental health reimbursement, in particular with multicentre studies that might find algorithms to split patients in more resource-homogeneous groups. Public Library of Science 2016-03-31 /pmc/articles/PMC4816317/ /pubmed/27031955 http://dx.doi.org/10.1371/journal.pone.0152669 Text en © 2016 Wolff et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Wolff, Jan
McCrone, Paul
Patel, Anita
Normann, Claus
Determinants of per diem Hospital Costs in Mental Health
title Determinants of per diem Hospital Costs in Mental Health
title_full Determinants of per diem Hospital Costs in Mental Health
title_fullStr Determinants of per diem Hospital Costs in Mental Health
title_full_unstemmed Determinants of per diem Hospital Costs in Mental Health
title_short Determinants of per diem Hospital Costs in Mental Health
title_sort determinants of per diem hospital costs in mental health
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816317/
https://www.ncbi.nlm.nih.gov/pubmed/27031955
http://dx.doi.org/10.1371/journal.pone.0152669
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