Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 7/2011

01-07-2011 | Original Paper

DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience

Authors: Riccardo Pertile, Valeria Donisi, Laura Grigoletti, Andrea Angelozzi, Giuseppe Zamengo, Grazia Zulian, Francesco Amaddeo

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 7/2011

Login to get access

Abstract

Purpose

This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy).

Methods

Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis.

Results

The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient’s local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation).

Conclusions

For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.
Literature
1.
de Girolamo G, Barbato A, Bracco R, Gaddini A, Miglio R, Morosini P, Norcio B, Picardi A, Rossi E, Rucci P, Santone G (2007) Dell’Acqua G; PROGRES-Acute group. Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy. Br J Psychiatry 191:170–177PubMedCrossRef
2.
de Girolamo G, Cozza M (2000) The Italian psychiatric reform. A 20-year perspective. Int J Law Psychiatry 23:197–214PubMedCrossRef
3.
Gaddini A, Biscaglia L, Bracco R, de Girolamo G, Miglio R, Norcio B, Rossi E, Rucci P, Santone G (2008) A one-day census of acute psychiatric inpatient facilities in Italy: findings from the PROGRES-Acute Project. Psychiatr Serv 59:722–724PubMedCrossRef
4.
Thornicroft G, Tansella M (2004) Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. Br J Psychiatry 185:283–290PubMedCrossRef
5.
Knapp M, Chisholm D, Astin J, Lelliott P, Audini B (1997) The cost consequences of changing the hospital–community balance: the mental health residential care study. Psychol Med 27:681–692PubMedCrossRef
6.
De Agostini P, Bonizzato P, Amaddeo F, Bisoffi G, Perali F, Tansella M (2001) For a more rational funding system of mental health services. Analyses of costs for services supplied by community mental health services during a 7-year period. Epidemiol Psichiatr Soc 10:163–179PubMed
7.
Knapp M, McDaid D, Amaddeo F, Constantopoulos A, Oliveira MD, Salvador Carulla L, Zechmeister I, The MHEEN Group (2007) Financing mental health care in Europe. J Ment Health 16:167–180CrossRef
8.
Taube C, Lee ES, Forthofer RN (1984) Diagnosis-related groups for mental disorders, alcoholism, and drug abuse: evaluation and alternatives. Hosp Community Psychiatry 35:452–455PubMed
9.
Schumacher DN, Namerow MJ, Parker B, Fox P, Kofie V (1986) Prospective payment for psychiatry-feasibility and impact. N Engl J Med 315:1331–1336PubMedCrossRef
10.
11.
English JT, Sharfstein SS, Scherl DJ, Astrachan B, Muszynski IL (1986) Diagnosis-related groups and general hospital psychiatry: the APA Study. Am J Psychiatry 143:131–139PubMed
12.
Mitchell JB, Dickey B, Liptzin B, Sederer LI (1987) Bringing psychiatric patients into the Medicare prospective payment system: alternatives to DRGs. Am J Psychiatry 144:610–615PubMed
13.
Essock-Vitale S (1987) Patient characteristics predictive of treatment costs on inpatient psychiatric wards. Hosp Community Psychiatry 38:263–269PubMed
14.
Kiesler CA, Simpkins C, Morton T (1990) Predicting length of hospital stay for psychiatric inpatients. Hosp Community Psychiatry 41:149–154PubMed
15.
Tucker P, Brems C (1993) Variables affecting length of psychiatric inpatient treatment. J Ment Health Adm 20:58–65PubMedCrossRef
16.
Nieminen P, Isohanni M, Winblad I (1994) Length of hospitalization in an acute patients’ therapeutic community ward. Acta Psychiatr Scand 90:466–472PubMedCrossRef
17.
Barnow S, Linden M, Schaub RT (1997) The impact of psychosocial and clinical variables on duration of inpatient treatment for depression. Soc Psychiatry Psychiatr Epidemiol 32:312–316PubMedCrossRef
18.
Creed F, Tomenson B, Anthony P, Tramner M (1997) Predicting length of stay in psychiatry. Psychol Med 27:961–966PubMedCrossRef
19.
Rocca P, Mingrone C, Mongini T, Montemagni C, Pulvirenti L, Rocca G, Bogetto F (2009) Outcome and length of stay in psychiatric hospitalization, the experience of the University Clinic of Turin. Soc Psychiatry Psychiatr Epidemiol (in press)
20.
Huntley DA, Cho DW, Christman J, Csernansky JG (1998) Predicting length of stay in an acute psychiatric hospital. Psychiatr Serv 49:1049–1053PubMed
21.
Oiesvold T, Saarento O, Sytema S, Christiansen L, Göstas G, Lönnerberg O, Muus S, Sandlund M, Hansson L (1999) The Nordic Comparative Study on Sectorized Psychiatry—length of in-patient stay. Acta Psychiatr Scand 100:220–228PubMedCrossRef
22.
Stevens A, Hammer K, Buchkremer G (2001) A statistical model for length of psychiatric in-patient treatment and an analysis of contributing factors. Acta Psychiatr Scand 103:203–211PubMedCrossRef
23.
Hopko DR, Lachar D, Bailley SE, Varner RV (2001) Assessing predictive factors for extended hospitalization at acute psychiatric admission. Psychiatr Serv 52:1367–1373PubMedCrossRef
24.
Blais MA, Matthews J, Lipkis-Orlando R, Lechner E, Jacobo M, Lincoln R, Gulliver C, Herman JB, Goodman AF (2003) Predicting length of stay on an acute care medical psychiatric inpatient service. Adm Policy Ment Health 31:15–29PubMedCrossRef
25.
Compton MT, Craw J, Rudisch BE (2006) Determinants of inpatient psychiatric length of stay in an urban county hospital. Psychiatr Q 77:173–188PubMedCrossRef
26.
Amaddeo F, Tansella M (2009) Information systems for mental health. Epidemiol Psichiatr Soc 18:1–4PubMed
27.
Plovnik RM (2009) Innovations in the utilization of health information technology in psychiatric services. Epidemiol Psichiatr Soc 18:5–11
28.
29.
Brendan Hemingway F (2008) DRG groupers software and services. A catalog, manual and reference. Cow and Calf Publishing, Branford
30.
Stata Corporation (2005) Stata statistical software: release 9. Stata Corporation LP, College Station, TX
31.
Cochran WG (1977) Sampling techniques. Wiley, Toronto
32.
Searle SR, Casella G, McCulloch CE (1992) Variance components. Wiley, New YorkCrossRef
33.
Veneto Region (2006) Deliberazione della Giunta n. 916, 28/03/2006
34.
Walsh PG, Currier G, Shah MN, Lyness JM, Friedman B (2008) Psychiatric emergency services for the US elderly: 2008 and beyond. Am J Geriatr Psychiatry 16:706–717PubMedCrossRef
35.
Garåsen H, Windspoll R, Johnsen R (2007) Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial. BMC Public Health 7:68PubMedCrossRef
36.
Lasalvia A, Gentile B, Ruggeri M et al (2007) Heterogeneity of the departments of mental health in the Veneto Region ten years after the National Plan 1994–96 for Mental Health. Which implication for clinical practice? Findings from the PICOS Project. Epidemiol Psichiatr Soc 16:59–70PubMed
37.
Lin HC, Lee HC (2009) Psychiatrists’ caseload volume, length of stay and mental healthcare readmission rates: a three-year population-based study. Psychiatry Res 166:15–23PubMedCrossRef
38.
Levene JE, Lancee W, Seeman MV, Skinner H, Freeman SJ (2009) Family and patient predictors of symptomatic status in schizophrenia. Can J Psychiatry 54:446–451PubMed
39.
Preti A, Rucci P, Santone G, Picardi A, Miglio R, Bracco R, Norcio B, de Girolamo G, PROGES-Acute group (2009) Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy. Psychol Med 39:485–496PubMedCrossRef
40.
Amaddeo F, Grigoletti L, de Girolamo G, Picardi A, Santone G (2007) Which factors affect the costs of psychiatric residential care? Findings from the Italian PROGRES study. Acta Psychiatr Scand 115:132–141PubMedCrossRef
Metadata
Title
DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience
Authors
Riccardo Pertile
Valeria Donisi
Laura Grigoletti
Andrea Angelozzi
Giuseppe Zamengo
Grazia Zulian
Francesco Amaddeo
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 7/2011
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-010-0231-1

Other articles of this Issue 7/2011

Social Psychiatry and Psychiatric Epidemiology 7/2011 Go to the issue

Original Paper

Repeated exposure to socioeconomic disadvantage and health selection as life course pathways to mid-life depressive and anxiety disorders

Original Paper

Rates of depression and anxiety in urban and rural Canada

Original Paper

Quality of life after postconflict displacement in Ethiopia: comparing placement in a community setting with that in shelters

Original Paper

Prevalence, correlates, and symptom profiles of depression among men with a history of military service

Original Paper

Psychiatric comorbidity in couples: a longitudinal study of 202,959 married and cohabiting individuals

Original Paper

Anticipated and experienced stigma among people with schizophrenia: its nature and correlates