DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience.
OBJECTIVE
This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy).


METHODS
Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis.


RESULTS
The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient's local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation).


CONCLUSIONS
For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.
Pertile
Riccardo
R
Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy. riccardo.pertile@univr.it
Donisi
Valeria
V
Grigoletti
Laura
L
Angelozzi
Andrea
A
Zamengo
Giuseppe
G
Zulian
Grazia
G
Amaddeo
Francesco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000191:economics* / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011567:Psychiatric Department, Hospital / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D012044:Regression Analysis; D055815:Young Adult
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