College of Social Work, University of Tennessee, 1618 Cumberland Ave., Knoxville, TN 37996, USA.
Psychiatr Serv. 2012 Sep 1;63(9):889-95. doi: 10.1176/appi.ps.201100412.
This study examined the extent to which hospital and regional characteristics are associated with length of hospitalization among patients with serious mental illness.
Data from the Pennsylvania Health Care Cost Containment Council and 2006 American Hospital Association data were obtained. The sample consisted of 106 hospitals from which 45,497 adults with serious mental illness were discharged in 2006. Guided by the extended version of Andersen's health care utilization model, hierarchical linear modeling, including patient case mix, hospital, and regional characteristics, was used to explain variations in hospitalization length.
The average length of stay was 10.0 ± 3.0 days. Stays were longer at psychiatric hospitals than at general acute care facilities and at hospitals with a greater percentage of Medicare patients and patients with serious mental illness and a higher rate of readmission. In terms of regional characteristics, stays were also longer at hospitals in counties where the county mental health program received a larger percentage of the state's mental health budget and a smaller share of the budget was used for residential care.
Hospital type and case mix, along with the presence of housing resources funded by county mental health programs, were found to be associated with variations in length of hospitalization. Further research of a longitudinal or prospective nature is required to determine whether the availability of housing programs for persons with mental disorders leads to shorter hospital stays for those in crisis and to determine whether longer stays are the result of differences in hospital practices.
本研究考察了医院和地区特征与严重精神疾病患者住院时间的关系。
数据来自宾夕法尼亚州医疗保健费用控制委员会和 2006 年美国医院协会的数据。样本包括 2006 年从 106 家医院出院的 45497 名患有严重精神疾病的成年人。基于安德森医疗保健利用模型的扩展版，采用分层线性模型，包括患者病例组合、医院和地区特征，解释住院时间的变化。
平均住院时间为 10.0 ± 3.0 天。精神科医院的住院时间长于综合急性护理设施，住院时间还与以下因素有关：医院中接受更多联邦医疗保险患者和严重精神疾病患者、再入院率较高、以及拥有更多的住房资源。在区域特征方面，在县精神卫生计划获得州精神卫生预算更大比例、以及用于住院治疗的预算份额较小的县的医院，住院时间也较长。
医院类型和病例组合，以及县精神卫生计划资助的住房资源的存在，与住院时间的变化有关。需要进一步进行纵向或前瞻性研究，以确定精神障碍患者住房项目的提供是否会导致危机中的患者住院时间缩短，并确定住院时间延长是否是医院实践差异的结果。
