Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-23T21:55:43.777Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnosis and length of psychiatric in-patient stay

Published online by Cambridge University Press:  09 July 2009

Paul McCrone  and
Michael Phelan
Paul McCrone*
Affiliation:
Psychiatric Research in Service Measurement, Institute of Psychiatry, London
Michael Phelan
Affiliation:
Psychiatric Research in Service Measurement, Institute of Psychiatry, London
*
1Address for correspondence: Mr Paul McCrone, Psychiatric Research in Service Management, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Get access Rights & Permissions [Opens in a new window]

Synopsis

This paper examines the link between diagnosis and length of psychiatric in-patient stay. Up to now the main method of predicting the use of in-patient services has been to use diagnosis-related groups (DRGs), primarily in the USA. Previous findings have revealed that DRGs generally predict less than 10% of variation in hospital stay. Psychiatric DRGs are considered to lack homogeneity and are too broad. Nevertheless, diagnosis, as an indicator of resource utilization, is now on the agenda in the UK and a study which examines the link between service use and diagnosis per se is called for. Altogether 5482 patients were allocated to 43 diagnostic categories (DCs). These DCs covered mental disorders, drug and alcohol-related problems, diseases of the nervous system and sense organs, and other related illnesses. Age was used in an attempt to refine the model further. Coefficients of variation were calculated for the DCs, and multivariate regression analysis was performed to gauge predictiveness. The results reveal that DCs contain extremely limited homogeneity and only predict 3% of variation in length of stay. When age group is included the results are only marginally improved, although the numbers contained in some DCs are low. Diagnosis, even when clearly defined, is a poor indicator of resource utilization.

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 4 , November 1994 , pp. 1025 - 1030
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anthony, P., Elphick, M. & Lelliott, P. (1993). Casemix in psychiatry. Psychiatric Bulletin 17, 8–9.CrossRefGoogle Scholar
Choca, J. P., Peterson, C. A., Shanley, L. A., Richards, H. & Mangoubi, E. (1988). Problems in using statistical models to predict psychiatric length of stay: an illustration. Hospital and Community Psychiatry 39, 195–197.Google ScholarPubMed
Coles, J. (1986). The myths and realities of DRGs in the NHS. Hospital and Health Services Review 82, 28–31.Google ScholarPubMed
Davies, L. M. & Drummond, L. F. (1990). The economic burden of schizophrenia. Psychiatric Bulletin 14, 522–525.CrossRefGoogle Scholar
Department of Health (1991). The Health of the Nation. HMSO: London.Google Scholar
Department of Health (1992). Health and Personal Social Services Statistics for England. HMSO: London.Google Scholar
English, J. T., Sharfstein, S. S., Scherl, D. J., Astrachan, B. & Muszynski, I. L. (1986). Diagnosis-related groups and general hospital psychiatry: the APA study. American Journal of Psychiatry 143, 131–139.Google ScholarPubMed
Essock, S. M. & Norquist, G. S. (1988). Toward a fairer prospective payment system. Archives of General Psychiatry 45, 1041–1044.CrossRefGoogle Scholar
Essock-Vitale, S. (1987). Patient characteristics predictive of treatment costs on in-patient psychiatric wards. Hospital and Community Psychiatry 38, 263–269.Google Scholar
Fetter, R. B., Shin, Y., Freeman, J. L., Averill, R. F. & Thompson, J. D. (1980). Case mix definition by diagnosis-related groups. Medical Care 18 (Suppl. No. 2), 1–53.Google ScholarPubMed
Fulop, G., Strain, J. J., Vita, J., Lyons, J. S. & Hammer, J. S. (1987). Impact of psychiatric comorbidity on length of hospital stay for medical/surgical patients: a preliminary report. American Journal of Psychiatry 144, 878–882.Google ScholarPubMed
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders: A Biosocial Model. Tavistock/Routledge: London.Google Scholar
Goldman, H. H., Pincus, H. A., Taube, C. A. & Regier, D. A. (1984). Prospective payment for psychiatric hospitalization: questions and issues. Hospital and Community Psychiatry 35, 460–464.Google ScholarPubMed
Horgan, C. & Jencks, S. F. (1987). Research on psychiatric classification and payment systems. Medical Care 25 (Suppl. No. 9), S22–S36.Google Scholar
Horn, S. D., Chambers, A. F., Sharkey, P. D. & Horn, R. A. (1989). Psychiatric severity of illness: a case mix study. Medical Care 27, 69–83.CrossRefGoogle ScholarPubMed
Kiesler, C. A. & Morton, T. L. (1988). Prospective payment system for in-patient psychiatry. American Psychologist 43, 141–150.CrossRefGoogle Scholar
Kiesler, C. A., Simpkins, C. & Morton, T. (1990). Predicting length of stay for psychiatric in-patients. Hospital and Community Psychiatry 41, 149–154.Google Scholar
Light, D. W., Phipps, E. J., Piper, G. E., Rissmiller, D. J., Mobilio, J. N. & Ranieri, W. F. (1986). Finding psychiatric diagnosis-related groups that work: a call for research. American Journal of Psychiatry 143, 622–624.Google Scholar
Lyons, J. S., O'Mahoney, M. T. & Larson, D. B. (1991). The attending psychiatrist as a predictor of length of stay. Hospital and Community Psychiatry 42, 1064–1066.Google ScholarPubMed
Mezzich, J. E. (1991). Architecture of clinical information and prediction of service utilization and cost. Schizophrenia Bulletin 17, 469–474.CrossRefGoogle ScholarPubMed
National Health Service Management Executive (1993). What are Healthcare Resource Groups? IMGME: Cambridge.Google Scholar
Oyebode, F., Cumella, S., Garden, G. & Binyon, S. (1990). Diagnosis-related groups: implications for psychiatry. Psychiatric Bulletin 14, 1–3.CrossRefGoogle Scholar
Parkin, D., Hutchinson, A., Philips, P. & Coates, J. (1993). A comparison of diagnosis related groups and ambulatory visit groups in day-case surgery. Health Trends 25, 41–44.Google ScholarPubMed
Royce, R. (1993). DRGs and the internal market. British Journal of Healthcare Computing 02, 27–28.Google Scholar
Sharfstein, S. S. & Beigel, A. (1984). Less is more? Today's economics and its challenge to psychiatry. American Journal of Psychiatry 141, 1403–1408.Google ScholarPubMed
Strathdee, G. & Thornicroft, G. (1992). Community sectors for needs led mental health services. In Measuring Mental Health Needs (ed. Thornicroft, G., Brewin, C. and Wing, J. K.). Royal College of Psychiatrists/Gaskell Press: London.Google Scholar
Taube, C. A., Goldman, H. H. & Lee, E. S. (1988). Use of speciality psychiatric settings in constructing DRGs. Archives of General Psychiatry 45, 1037–1040.CrossRefGoogle ScholarPubMed