Abstract
BackgroundUnderstanding the long-term inpatient service cost and utilization of psychiatric patients may provide insight into service demand for these patients and guide the design of targeted mental health programs. This study assesses 3-year hospitalization patterns and quantifies service utilization intensity of psychiatric patients in Beijing, China.MethodsWe identified patients admitted for one of three major psychiatric disorders (schizophrenia, bipolar and depressive disorders) between January 1 and December 31, 2013 in Beijing, China. Inpatient admissions during the following 3 years were extracted and analyzed using sequence analysis. Clinical characteristics, psychiatric and non-psychiatric service use of included patients were analyzed.ResultsThe study included 3443 patients (7657 hospitalizations). The patient hospitalization sequences were grouped into 4 clusters: short stay (N = 2741 (79.61% of patients), who had 126,911 or 26.82% of the hospital days within the sample), repeated long stay (N = 404 (11.73%), 76,915 (16.26%) days), long-term stay (N = 101 (2.93%), 59,909 (12.66%) days) and permanent stay (N = 197 (5.72%), 209,402 (44.26%) days). Length and frequency of hospitalization, as well as readmission rates were significantly different across the 4 clusters. Over the 3-year period, hospitalization days per year decreased for patients in the short stay and repeated long stay clusters. Patients with schizophrenia (1705 (49.52%)) had 78.4% of cumulative psychiatric stays, with 11.14% of them in the permanent stay cluster. Among patients with depression, 23.11% had non-psychiatric hospitalizations, and on average 46.65% of their total inpatient expenses were for non-psychiatric care, the highest among three diagnostic groups.ConclusionHospitalization patterns varied significantly among psychiatric patients and across diagnostic categories. The high psychiatric care service use of the long-term and permanent stay patients underlines the need for evidence-based interventions to reduce cost and improve care quality.
Highlights
Disease burden of mental illnesses Mental and addictive disorders accounted for 6.8% of global burden of disease (measured by disability-adjusted life years (DALYs)) [1]
Characteristics of the identified clusters Based on the sequence analysis and cluster analysis, we classified the patient hospitalization sequences into four clusters: short stay (n = 2741, 79.61%), repeated long stay
Hospitalization patterns varied across diagnostic groups We found that patients with schizophrenia accounted for more than 90% of the long-term stay and permanent stay clusters, which was consistent with findings from Golay et al [21]
Summary
Disease burden of mental illnesses Mental and addictive disorders accounted for 6.8% of global burden of disease (measured by disability-adjusted life years (DALYs)) [1]. Severe psychiatric disorders such as schizophrenia, bipolar disorder, and depressive disorder (especially major depression disorder) were among the leading causes of years lived with disability (YLD) [2, 3] and were recognized as major psychiatric disorders by previous studies [2, 4]. The importance of understanding inpatient psychiatric care Understanding the long-term inpatient service cost and utilization of psychiatric patients can quantify the service demand for these patients and guide the design of targeted community-level mental health programs. This study assesses 3-year hospitalization patterns and quantifies service utilization intensity of psychiatric patients in Beijing, China
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