Length of inpatient stay of persons with serious mental illness: effects of hospital and regional characteristics.

OBJECTIVE

This study examined the extent to which hospital and regional characteristics are associated with length of hospitalization among patients with serious mental illness.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.