title: Predictors of Hospital Length and Cost of Stay in a National Sample of Adult Patients with Psychotic Disorders.
abstract: OBJECTIVE
  This study examined effects of patient-level and hospital-level characteristics on length and cost of hospital stays among adult patients with psychotic disorders.
  
  
  METHODS
  A subsample of 677,684 adult patients with a primary diagnosis of a psychotic disorder was drawn from the 2003-2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. A nationally representative survey design and census data were used to calculate hospitalization rates. Multilevel models examined variation in length and cost of stay in relation to individual (age, sex, race-ethnicity, household income, payer source, and illness severity) and hospital (region, urban or rural location, ownership, teaching status, and size) characteristics.
  
  
  RESULTS
  Admission rates differed dramatically by region, with higher rates in the Northeast. Compared with white patients, African Americans had higher admission rates but shorter stays and lower costs, and Asians/Pacific Islanders and Native Americans had longer stays. Longer stays were also associated with higher versus lower illness severity and use of Medicaid and Medicare versus private insurance. Length and cost of stays were greater in Northeast hospitals and in public hospitals.
  
  
  CONCLUSIONS
  Strong differences were noted in use of hospitalization to treat psychotic disorders. Higher admission rates and longer stays in the Northeast were striking, as were differences in admission rates and length of stay for African-American patients compared with white patients. Future research should investigate the appropriateness of acute care use from an overuse (Northeast) and underuse (West) perspective. Findings raise questions about the effects of health reform on adult acute care use and have implications for mental health and hospital policy.
authors.affiliation: Dr. Bessaha is with the School of Social Welfare, Stony Brook University, Stony Brook, New York (e-mail: melissa.bessaha@stonybrook.edu ). Dr. Shumway is with the Department of Psychiatry, University of California, San Francisco. Dr. Smith, Dr. Bright, and Dr. Unick are with the School of Social Work, University of Maryland, Baltimore.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Bessaha
authors.affiliation: Dr. Bessaha is with the School of Social Welfare, Stony Brook University, Stony Brook, New York (e-mail: melissa.bessaha@stonybrook.edu ). Dr. Shumway is with the Department of Psychiatry, University of California, San Francisco. Dr. Smith, Dr. Bright, and Dr. Unick are with the School of Social Work, University of Maryland, Baltimore.
authors.forename: Martha
authors.initials: M
authors.lastname: Shumway
authors.affiliation: Dr. Bessaha is with the School of Social Welfare, Stony Brook University, Stony Brook, New York (e-mail: melissa.bessaha@stonybrook.edu ). Dr. Shumway is with the Department of Psychiatry, University of California, San Francisco. Dr. Smith, Dr. Bright, and Dr. Unick are with the School of Social Work, University of Maryland, Baltimore.
authors.forename: Melissa Edmondson
authors.initials: ME
authors.lastname: Smith
authors.affiliation: Dr. Bessaha is with the School of Social Welfare, Stony Brook University, Stony Brook, New York (e-mail: melissa.bessaha@stonybrook.edu ). Dr. Shumway is with the Department of Psychiatry, University of California, San Francisco. Dr. Smith, Dr. Bright, and Dr. Unick are with the School of Social Work, University of Maryland, Baltimore.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Bright
authors.affiliation: Dr. Bessaha is with the School of Social Welfare, Stony Brook University, Stony Brook, New York (e-mail: melissa.bessaha@stonybrook.edu ). Dr. Shumway is with the Department of Psychiatry, University of California, San Francisco. Dr. Smith, Dr. Bright, and Dr. Unick are with the School of Social Work, University of Maryland, Baltimore.
authors.forename: George J
authors.initials: GJ
authors.lastname: Unick
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D018166:Health Care Reform; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D055361:Multilevel Analysis; D010343:Patient Admission / Q000706:statistics & numerical data* / Q000639:trends; D011618:Psychotic Disorders / Q000191:economics* / Q000453:epidemiology; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Community psychiatry; Hospitalization; Length of stay; Psychotic disorders; Schizophrenia