Lindenfeld Zoe, Cantor Jonathan H, McCullough Colleen M, Bather Jemar R, McBain Ryan K
Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey, United States of America.
RAND Corporation, Santa Monica, California, United States of America.
PLoS Med. 2025 Jul 23;22(7):e1004682. doi: 10.1371/journal.pmed.1004682. eCollection 2025 Jul.
Despite persistently high rates of mental illness and suicide, receipt of treatment for mental health conditions remains low. In this context, it is important to quantify the number of inpatient psychiatric beds (IPBs), and to understand differences in the number of IPBs throughout the U.S, as these provide critical evaluation, medication, and stabilization services.
This study used nationally-representative data drawn from the 2011-2023 Centers for Medicare and Medicaid Services' Healthcare Cost Report Information System (HCRIS). From 2011-2023, while the total number of IPBs-in both psychiatric hospitals (PHs) and short-term acute care hospitals (STACHs)-did not change, the number IPBs within STACHs fell from 11.3 in 2011 to 9.06 in 2023. During this period, 846 counties (in which over 244 million individuals reside) experienced a decline in the rate of IPBs, while another 1,449 counties (in which 59 million individuals reside) never had IPBs. In regression models predicting the number of IPBs in STACHs and PHs, hospitals that received DSH payments (STACHs: IRR:1.93, 95% CI: 1.72, 2.15; PHs: IRR:1.40; 95% CI: 1.06, 1.84), had more full-time employees (STACHs: IRR:1.35, 95% CI: 1.31, 1.38; PHs: IRR:1.77; 95% CI: 1.75, 1.80) and were teaching STACHs (STACHs: IRR:1.78; 95% CI: 1.63, 1.95) had significantly more IPBs. In county-level regression models, counties with a lower percentage of Black residents (β: -21.15; 95% CI: -37.14, -5.16) had a significantly higher rate of IPBs. The absence of a causal design means we cannot assess the reasons behind changes in IPBs across time, and is a limitation of this study.
This study provides an overview of the availability of IPBs throughout the U.S, as well as the number of individuals without access to IPBs. Findings indicate a dearth of STACH-based IPBs, particularly in areas with a greater proportion of racial minority residents.
尽管精神疾病和自杀率持续居高不下，但接受心理健康治疗的比例仍然很低。在这种情况下，量化住院精神科床位（IPB）的数量，并了解美国各地IPB数量的差异非常重要，因为这些床位提供关键的评估、药物治疗和稳定服务。
本研究使用了2011 - 2023年医疗保险和医疗补助服务中心医疗成本报告信息系统（HCRIS）中的全国代表性数据。从2011年到2023年，精神病医院（PH）和短期急性护理医院（STACH）的IPB总数没有变化，但STACH内的IPB数量从2011年的11.3张降至2023年的9.06张。在此期间，846个县（超过2.44亿人居住）的IPB率下降，另有1449个县（5900万人居住）从未有过IPB。在预测STACH和PH中IPB数量的回归模型中，接受DSH支付的医院（STACH：风险比：1.93，95%置信区间：1.72，2.15；PH：风险比：1.40；95%置信区间：1.06，1.84）、全职员工更多的医院（STACH：风险比：1.35，95%置信区间：1.31，1.38；PH：风险比：1.77；95%置信区间：1.75，1.80）以及教学STACH（STACH：风险比：1.78；95%置信区间：1.63，1.95）的IPB明显更多。在县级回归模型中，黑人居民比例较低的县（β：-21.15；95%置信区间：-37.14，-5.16）的IPB率明显更高。缺乏因果设计意味着我们无法评估IPB随时间变化的背后原因，这是本研究的一个局限性。
本研究概述了美国各地IPB的可用性，以及无法获得IPB的人数。研究结果表明，基于STACH的IPB短缺，特别是在少数族裔居民比例较高的地区。
