[Heavy users in a psychiatric hospital--a cohort study on 1811 patients over five years].
OBJECTIVE
The aim of the study was to examine the extent of use of acute psychiatric inpatient care, and to determine sociodemographic and disease-related characteristics of so called "heavy users".


METHODS
A cohort of 1811 patients with first hospitalisation in 1995 was followed by means of the German psychiatric basic documentation (DGPPN-BADO) over a five-year period from 1995 to 1999.


RESULTS
The average cumulative length of stay was 63.2 days (SD 98.4), the median 32 days. 5 % of patients stayed in hospital more than 238 days and 1 % even more than 538.1 days within five years. 50 % of patients "consumed" only 10 % of inpatient days, whereas other 10 % of patients accounted for nearly 50 % of the resources. By means of a regression analysis ten significant predictors for a long cumulative hospital stay could be found, e. g. schizophrenia, personality disorder, socio-therapeutic modalities, sheltered living, and low psychosocial capability (GAF) at discharge. Within five years an average number of hospital stays of 1.8 (SD 2.1) was found. 5 % of patients had more than four inpatient stays, 1 % even more than ten. Regressions analysis revealed seven significant predictors for a high number of hospital stays, e. g. alcohol dependence, comorbid alcohol abuse, and a short interval between first and second admission.


CONCLUSIONS
As no distinct group of "heavy user" could be identified, individual treatment strategies should be addressed, and qualitative studies and in-depth statistic analyses must be performed.
Spiessl
Hermann
H
Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität am Bezirksklinikum Regensburg, Germany. hermann.spiessl@bkr-regensburg.de
Hübner-Liebermann
Bettina
B
Binder
Harald
H
Cording
Clemens
C
D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D009313:National Health Programs / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010554:Personality Disorders / Q000453:epidemiology / Q000534:rehabilitation; D012044:Regression Analysis; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000534:rehabilitation; D014600:Utilization Review / Q000706:statistics & numerical data