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

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

Warnkeetal.BMCPsychiatry2011,11:120 /1471-244X/11/120 RESEARCH ARTICLE OpenAccess Doespsychopathologyatadmissionpredictthe lengthofinpatientstayinpsychiatry? Implicationsforfinancingpsychiatricservices IngeborgWarnke*,WulfR?sslerandUweHerwig Abstract Background:Thedebateonappropriatefinancingsystemsininpatientpsychiatryisongoing.Inthiscontext,itis importanttocontrolresourceuseintermsoflengthofstay(LOS),whichisthemostcostlyfactorininpatientcare andtheonethatcanbeinfluencedmosteasily.Previousstudieshaveshownthatpsychiatricdiagnosesprovide onlylimitedjustificationforexplainingvariationinLOS,andithasbeensuggestedthatmeasuressuchas psychopathologymightbemoreappropriatetopredictresourceuse.Therefore,weinvestigatedtherelationship betweenLOSandpsychopathologicalsyndromesorsymptomsatadmissionaswellasothercharacteristicssuchas sociodemographicandclinicalvariables. Methods:WeconsideredroutinemedicaldataofpatientsadmittedtothePsychiatricUniversityHospitalZurichin theyears2008and2009.Completedataonpsychopathologyathospitaladmissionwereavailablein3,220 inpatientepisodes.Asubsampleof2,939inpatientepisodeswasconsideredinfinalstatisticalmodels,including psychopathologyaswellascompletedatasetsoffurthermeasures(e.g.sociodemographic,clinical,treatment- relatedandpsychosocialvariables).Weusedmultivariatelinearaswellaslogisticregressionanalysiswithforward selectionproceduretodeterminethepredictorsofLOS. Results:Allbuttwosyndromescores(mania,hostility)werepositivelyrelatedtothelengthofstay.Finalstatistical modelsshowedthatsyndromesorsymptomsexplainedabout5%ofthevariationinlengthofstay.Theinclusion ofsyndromesorsymptomsaswellasbasictreatmentvariablesandotherfactorsledtoanexplainedvariationof upto25%. Conclusions:Psychopathologicalsyndromesandsymptomsatadmissionandfurthercharacteristicsonlyexplained asmallproportionofthelengthofinpatientstay.Thus,accordingtooursample,psychopathologymightnotbe suitableasaprimaryindicatorforestimatingLOSandcontingentcosts.Thismightbeconsideredinthe develop