Psychopathologische Syndrome gemäß AMDP-System als Grundlage für Fallgruppierungen in der Psychiatrie

Herwig, Uwe; Warnke, Ingeborg; Rössler, Wulf

doi:10.1055/s-0029-1220355

Cited by 4 publications

(6 citation statements)

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“…Our results enhance previous findings on the predictive power of syndromes with a smaller sample [20], as here psychopathological symptoms also do not allow sufficient prediction of LOS. Other clinical variables besides psychopathology such as substance abuse or severity of illness at admission had a minor influence on the length of stay as well, which is in line with previous findings taking several hospitals in a whole catchment area into account while controlling for the factor "hospital" [11].…”

Section: Discussionsupporting

confidence: 51%

“…A recent pilot study showed that psychopathological syndromes at hospital admission explained less than 10% of the variation in length of stay in Swiss psychiatric inpatient care [20]. However, those findings have to be regarded as preliminary due to small sample size and limited analyses.…”

Section: Introductionmentioning

confidence: 99%

“…In this respect, our study adds on a previous investigation on syndromes and LOS that considered only a small sample [20]. Further, we considered other routinely collected variables that are usually mentioned as basic grouping criteria of DGRs or are cited as some of the most relevant predictor variables of LOS in the literature (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

2011

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BackgroundThe debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS), which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables.MethodsWe considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables). We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS.ResultsAll but two syndrome scores (mania, hostility) were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%.ConclusionsPsychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent costs. This might be considered in the development of future costing systems in psychiatry.

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Section: Discussionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

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Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

2011

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“…Four studies provide detailed information on how the functional variables were assessed. The remaining studies ( n = 6 ) only give summary information, such as “cognitive status” [ 38 ], “mobility” [ 39 ], “functional level before and after stroke” [ 40 ], “independent/dependent in 1 or more ADLs” [ 41 ], “self-care functions” [ 42 ], or “global assessment of functioning” [ 43 ] without any further variable specifications. In those studies that provided further specification, the most commonly assessed aspects of functioning were toileting ( n = 3 ), eating ( n = 3 ), bathing ( n = 2 ), dressing ( n = 2 ), and transferring ( n = 2 ) [ 44 – 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…Consistently with the other studies, patients dependent in physical functioning stayed up to 40 % longer than patients with lower dependency when controlling for HRG [ 47 ]. For systems being developed for other settings, such as geriatric medicine or mental health, the addition of functioning information increased explained variance for LOS from 13.0 % to 19.2 % or from 5.9 % to 19.8 % [ 39 , 43 ]. Adding functioning information into Johns Hopkins ACG/DCG casemix systems for predicting inpatient/outpatient and total days of care for inpatient and outpatient veterans did not reveal great improvement in the systems’ predictive power in the study extracted [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

Capturing patients’ needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems

Hopfe

Stucki

Marshall

et al. 2015

BMC Health Serv Res

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BackgroundContemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients’ needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay.MethodsA systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological Abstracts using keywords related to functioning (‘Functioning’, ‘Functional status’, ‘Function*, ‘ICF’, ‘International Classification of Functioning, Disability and Health’, ‘Activities of Daily Living’ or ‘ADL’) and casemix systems (‘Casemix’, ‘case mix’, ‘Diagnosis Related Groups’, ‘Function Related Groups’, ‘Resource Utilization Groups’ or ‘AN-SNAP’). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors’ discussion of results, study limitations and implications was extracted.ResultsTen included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest that, in particular, DRG casemix systems can be improved in predicting resource use and capturing outcomes for frail elderly or severely functioning-impaired patients.ConclusionFurther exploration of the value of adding functioning information into casemix systems is one promising approach to improve casemix systems ability to adequately capture the differences in patient’s needs for services and to better predict resource use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1277-x) contains supplementary material, which is available to authorized users.

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Factors Associated with Length of Stay in a Swiss Mental Hospital

Habermeyer

Gennaro²,

Frizi³

et al. 2018

Psychiatr Q

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The aim of this study was to identify factors which are associated with the length of stay in a Swiss mental hospital. Demographical and clinical data of all patients who were admitted to the adult inpatient psychiatric service of the Federal State of Aargau in 2016 were examined regarding their association with the length of stay. The study sample included N = 1479 patients. Mean length of stay was 33 days and the median equalled 26 days. Higher age and a primary diagnosis of psychotic or affective disorder were associated with increased length of stay. In contrast, foreign nationality and compulsory admission were associated with reduced length of stay. While some of our findings were in line with recent findings from Italy and the United Kingdom, others could not be replicated.

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Psychopathologische Syndrome gemäß AMDP-System als Grundlage für Fallgruppierungen in der Psychiatrie

Abstract: Our pilot study does not imply AMDP syndromes to be suitable for a case grouping to estimate costs. Other analytical approaches using AMDP syndromes may lead to a better prediction, however, its use shall be regarded critically.

Cited by 4 publications

References 5 publications

Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

Capturing patients’ needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems

Factors Associated with Length of Stay in a Swiss Mental Hospital

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