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Determinants of per diem Hospital Costs in Mental Health.

Wolff J, McCrone P, Patel A, Normann C - PLoS ONE (2016)

Bottom Line: Mixed-effects maximum likelihood regression and an ensemble of conditional inference trees were used to analyse data.Although reliable cost drivers were identified, idiosyncrasies of mental health care complicated the identification of clear and consistent differences in hospital costs between patient groups.Further research could greatly inform current discussions about inpatient mental health reimbursement, in particular with multicentre studies that might find algorithms to split patients in more resource-homogeneous groups.

View Article: PubMed Central - PubMed

Affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, King's Health Economics, De Crespigny Park, London, United Kingdom.

ABSTRACT

Introduction: An understanding of differences in hospital costs between patient groups is relevant for the efficient organisation of inpatient care. The main aim of this study was to confirm the hypothesis that eight a priori identified cost drivers influence per diem hospital costs. A second aim was to explore further variables that might influence hospital costs.

Methods: The study included 667 inpatient episodes consecutively discharged in 2014 at the psychiatric hospital of the Medical Centre-University of Freiburg. Fifty-one patient characteristics were analysed. Per diem costs were calculated from the hospital perspective based on a detailed documentation of resource use. Mixed-effects maximum likelihood regression and an ensemble of conditional inference trees were used to analyse data.

Results: The study confirmed the a priori hypothesis that not being of middle age (33-64 years), danger to self, involuntary admission, problems in the activities of daily living, the presence of delusional symptoms, the presence of affective symptoms, short length of stay and the discharging ward affect per diem hospital costs. A patient classification system for prospective per diem payment was suggested with the highest per diem hospital costs in episodes having both delusional symptoms and involuntary admissions and the lowest hospital costs in episodes having neither delusional symptoms nor somatic comorbidities.

Conclusion: Although reliable cost drivers were identified, idiosyncrasies of mental health care complicated the identification of clear and consistent differences in hospital costs between patient groups. Further research could greatly inform current discussions about inpatient mental health reimbursement, in particular with multicentre studies that might find algorithms to split patients in more resource-homogeneous groups.

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Partial residuals of mean per diem costs versus length of stay.
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pone.0152669.g001: Partial residuals of mean per diem costs versus length of stay.

Mentions: Fig 1 shows the association between observed lengths of stay and mean per diem costs in a component-plus-residuals plot. It plots the observed length of stay against the residuals of regressing per diem costs on the variables that represented the eight potential cost drivers plus the component associated with length of stay. Controlling for the other variables, per diem costs declined until a total length of stay of about five weeks. Thereafter, they remained mainly constant. An increase in per diem costs in episodes with a length of stay above 150 days was associated with a few outlier episodes, as indicated by the superimposed box-plot. Therefore, length of stay was dichotomised in the following analyses and patients staying no more than five weeks were separated from others.


Determinants of per diem Hospital Costs in Mental Health.

Wolff J, McCrone P, Patel A, Normann C - PLoS ONE (2016)

Partial residuals of mean per diem costs versus length of stay.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4816317&req=5

pone.0152669.g001: Partial residuals of mean per diem costs versus length of stay.
Mentions: Fig 1 shows the association between observed lengths of stay and mean per diem costs in a component-plus-residuals plot. It plots the observed length of stay against the residuals of regressing per diem costs on the variables that represented the eight potential cost drivers plus the component associated with length of stay. Controlling for the other variables, per diem costs declined until a total length of stay of about five weeks. Thereafter, they remained mainly constant. An increase in per diem costs in episodes with a length of stay above 150 days was associated with a few outlier episodes, as indicated by the superimposed box-plot. Therefore, length of stay was dichotomised in the following analyses and patients staying no more than five weeks were separated from others.

Bottom Line: Mixed-effects maximum likelihood regression and an ensemble of conditional inference trees were used to analyse data.Although reliable cost drivers were identified, idiosyncrasies of mental health care complicated the identification of clear and consistent differences in hospital costs between patient groups.Further research could greatly inform current discussions about inpatient mental health reimbursement, in particular with multicentre studies that might find algorithms to split patients in more resource-homogeneous groups.

View Article: PubMed Central - PubMed

Affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, King's Health Economics, De Crespigny Park, London, United Kingdom.

ABSTRACT

Introduction: An understanding of differences in hospital costs between patient groups is relevant for the efficient organisation of inpatient care. The main aim of this study was to confirm the hypothesis that eight a priori identified cost drivers influence per diem hospital costs. A second aim was to explore further variables that might influence hospital costs.

Methods: The study included 667 inpatient episodes consecutively discharged in 2014 at the psychiatric hospital of the Medical Centre-University of Freiburg. Fifty-one patient characteristics were analysed. Per diem costs were calculated from the hospital perspective based on a detailed documentation of resource use. Mixed-effects maximum likelihood regression and an ensemble of conditional inference trees were used to analyse data.

Results: The study confirmed the a priori hypothesis that not being of middle age (33-64 years), danger to self, involuntary admission, problems in the activities of daily living, the presence of delusional symptoms, the presence of affective symptoms, short length of stay and the discharging ward affect per diem hospital costs. A patient classification system for prospective per diem payment was suggested with the highest per diem hospital costs in episodes having both delusional symptoms and involuntary admissions and the lowest hospital costs in episodes having neither delusional symptoms nor somatic comorbidities.

Conclusion: Although reliable cost drivers were identified, idiosyncrasies of mental health care complicated the identification of clear and consistent differences in hospital costs between patient groups. Further research could greatly inform current discussions about inpatient mental health reimbursement, in particular with multicentre studies that might find algorithms to split patients in more resource-homogeneous groups.

Show MeSH
Related in: MedlinePlus