Thienhaus O J
University of Cincinnati Medical Center, Department of Psychiatry, Ohio 45267-0559.
Eur Arch Psychiatry Neurol Sci. 1987;236(5):299-302. doi: 10.1007/BF00380956.
Due to administratively mandated changes in the reimbursement system for inpatient treatment, average length of hospital stay in a geropsychiatric hospital unit decreased by approximately 20% within 1 year. The impact of this change on selected key parameters of effective therapeutic management are analyzed. Three 90-day periods were compared, one before, two after the reduction in length of stay. It was found that postdischarge referrals to facilities with a higher level of restrictiveness than prior to hospitalization increased significantly from Period 1 to Period 2, but returned to the original level in Period 3. These findings were confirmed when data were corrected for changes in the diagnostic composition of the respective samples. Patients who lacked natural support systems were more likely to be referred to a postdischarge setting of greater restrictiveness than before the admission. This finding remained constant. Readmission figures increased by 5% immediately after introduction of the decreased average length of stay (Period 2). When corrected for diagnostic composition, early recidivism also returned to original level in Period 3. Patients' insurance status appeared unrelated to any of the measured variables. Some observations on the composition of the diagnostic mosaic among admissions over time and the relations between diagnostic categories and average length of stay are included.
由于住院治疗报销制度的行政性强制变更，一家老年精神病医院科室的平均住院时长在1年内减少了约20%。分析了这一变更对有效治疗管理选定关键参数的影响。比较了三个90天时间段，一个在住院时长缩短之前，两个在住院时长缩短之后。结果发现，从第1阶段到第2阶段，出院后转至比住院前限制级别更高的机构的转诊显著增加，但在第3阶段恢复到原来的水平。当对各样本的诊断构成变化进行数据校正时，这些发现得到了证实。缺乏自然支持系统的患者比入院前更有可能被转至出院后限制级别更高的环境。这一发现保持不变。平均住院时长缩短实施后（第2阶段），再入院率立即上升了5%。经诊断构成校正后，早期复发率在第3阶段也恢复到原来的水平。患者的保险状况似乎与任何测量变量均无关。文中还包括了对不同时间入院患者诊断组合构成以及诊断类别与平均住院时长之间关系的一些观察结果。
