Ms. Rasmussen, Dr. Mainz, and Dr. Johnsen are with the Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Dr. Mainz and Dr. Johnsen, along with Dr. Jørgensen, are also with Aalborg University Hospital, Aalborg, where Dr. Mainz and Dr. Jørgensen are with the Department of Psychiatry. Dr. Videbech is with the Center for Neuropsychiatric Depression Research, Mental Health Center, Copenhagen University Hospital, Glostrup, Denmark.
Psychiatr Serv. 2018 Jul 1;69(7):797-803. doi: 10.1176/appi.ps.201700426. Epub 2018 Apr 26.
The relationship between inpatient volume and the quality of mental health care remains unclear. This study examined the association between inpatient volume in psychiatric hospital wards and quality of mental health care among patients with depression admitted to wards in Denmark.
In a nationwide, population-based cohort study, 17,971 patients (N=21,120 admissions) admitted to psychiatric hospital wards between 2011 and 2016 were identified from the Danish Depression Database. Inpatient volume was categorized into quartiles according to the individual ward's average caseload volume per year during the study period: low volume (quartile 1, <102 inpatients per year), medium volume (quartile 2, 102-172 inpatients per year), high volume (quartile 3, 173-227 inpatients per year) and very high volume (quartile 4, >227 inpatients per year). Quality of mental health care was assessed by receipt of process performance measures reflecting national clinical guidelines for care of depression.
Compared with patients admitted to low-volume psychiatric hospital wards, patients admitted to very-high-volume wards were more likely to receive a high overall quality of mental health care (≥80% of the recommended process performance measures) (adjusted relative risk [ARR]=1.78, 95% confidence interval [CI]=1.02-3.09) as well as individual processes of care, including a somatic examination (ARR=1.35, CI=1.03-1.78).
Admission to very-high-volume psychiatric hospital wards was associated with a greater chance of receiving guideline-recommended process performance measures for care of depression.
住院患者人数与精神卫生保健质量之间的关系尚不清楚。本研究调查了丹麦精神病院病房住院患者人数与抑郁症患者精神卫生保健质量之间的关系。
在一项全国性、基于人群的队列研究中，从丹麦抑郁症数据库中确定了 2011 年至 2016 年间在精神病院病房住院的 17971 名患者（N=21120 人次住院）。根据研究期间每个病房的平均每年住院人数，将住院人数分为四组：低住院人数（第 1 组，每年<102 名住院患者）、中等住院人数（第 2 组，每年 102-172 名住院患者）、高住院人数（第 3 组，每年 173-227 名住院患者）和极高住院人数（第 4 组，每年>227 名住院患者）。通过评估反映国家抑郁症治疗临床指南的过程绩效指标来评估精神卫生保健质量。
与入住低住院人数精神病院病房的患者相比，入住极高住院人数精神病院病房的患者更有可能获得较高的整体精神卫生保健质量（接受了推荐的精神卫生保健质量过程绩效指标的 80%以上）（调整后的相对风险[ARR]=1.78，95%置信区间[CI]=1.02-3.09），以及个别护理过程，包括体检（ARR=1.35，CI=1.03-1.78）。
入住极高住院人数精神病院病房与获得推荐的抑郁症治疗过程绩效指标的机会更大相关。
