Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.
J Psychosom Res. 2010 Mar;68(3):295-302. doi: 10.1016/j.jpsychores.2009.04.010. Epub 2009 Sep 30.
Although there is a suggestion that the medical psychiatric unit (MPU) may reduce length of hospital stay (LOS), little is known about costs in terms of medical service use and psychiatric interventions in MPU care.
A record linkage study was conducted, linking cost data of hospital medical service use, LOS, and hospital psychiatric interventions to patients admitted to the MPU of the Maastricht University Medical Centre (MUMC) between 1998 and 2004. The data set was analyzed to enable comparison between cost changes of the same complex patient population following either MPU index admission or index admissions to reference MUMC medical wards.
Comparisons revealed lower costs of medical service use in favor of the MPU (-euro104; 95% CI -euro174 to -euro35; P<.01). However, cost of psychiatric intervention and cost of LOS were higher after MPU admission (respectively, +euro165; 95% CI +euro25 to +euro305; P<.05; and +euro202; 95% CI +euro170 to +euro235; P<.001). Total costs were higher after MPU admission compared to medical ward admission (+euro263; 95% CI +euro68 to +euro458; P<.05). These differences were not moderated by somatic diagnosis or previous pattern of admissions.
The findings suggest that patients at the interface of psychiatric and somatic morbidity are diagnosed and treated adequately at the MPU, leading to a decrease in medical service use and an appropriate increase in exposure to psychiatric interventions. These results are specifically generalizable to MPUs with a focus on psychosomatic conditions, for instance, somatoform disorders or affective disorders with comorbid somatic diseases. However, failure to show cost savings in terms of LOS compared to medical wards outweighs cost-benefit derived from lower medical service use, suggesting that MPU activities may gain in cost-effectiveness if shifted more to outpatient psychosomatic care solutions.
尽管有研究表明，精神科医疗联合病房（MPU）可以缩短住院时间（LOS），但对于 MPU 护理在医疗服务使用和精神科干预方面的成本却知之甚少。
本研究进行了一项病历关联研究，将医院医疗服务使用、LOS 和医院精神科干预的成本数据与 1998 年至 2004 年期间入住马斯特里赫特大学医学中心（MUMC）MPU 的患者相关联。对数据集进行了分析，以便比较同一复杂患者群体在 MPU 指数入院或 MUMC 内科病房指数入院后成本变化。
比较结果显示，MPU 有利于降低医疗服务使用成本（-104 欧元；95%置信区间-174 至-35 欧元；P<.01）。然而，MPU 入院后精神科干预和 LOS 成本更高（分别为+165 欧元；95%置信区间+25 至+305 欧元；P<.05；+202 欧元；95%置信区间+170 至+235 欧元；P<.001）。与内科病房入院相比，MPU 入院后总费用更高（+263 欧元；95%置信区间+68 至+458 欧元；P<.05）。这些差异不受躯体诊断或既往入院模式的影响。
研究结果表明，处于精神和躯体疾病交界处的患者在 MPU 得到了充分的诊断和治疗，导致医疗服务使用减少，适当增加了精神科干预。这些结果特别适用于以心身疾病为重点的 MPU，例如躯体形式障碍或伴有躯体疾病的情感障碍。然而，与内科病房相比，MPU 在 LOS 方面没有显示出成本节约，这超过了因医疗服务使用减少而带来的成本效益，这表明如果将 MPU 活动更多地转向门诊心身护理解决方案，其活动将更具成本效益。
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