Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation

Mattias Strand,Cynthia M Bulik,Sanna A Gustafsson,Elisabeth Welch

doi:10.1186/s12913-021-06478-1

Abstract

BackgroundSelf-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants’ need for inpatient treatment, but that it does not alone lead to symptom remission.MethodsThe aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders.ResultsParticipants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this “win-win situation” occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction.ConclusionsFor healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization.Trial RegistrationClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).

Highlights

Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding
The aim of the present analysis is to evaluate if, from a healthcare service provider perspective, the reallocation of resources associated with the introduction of selfadmission is justified, such that the reduction of hospital beds available for regular patients on the waiting list is offset by the observed reduction in healthcare utilization for the program participants
On average, the utilization of regular inpatient treatment at Stockholm Centre for Eating Disorders (SCÄ) for participants was reduced by 84.7 days

Summary

Introduction

Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants’ need for inpatient treatment, but that it does not alone lead to symptom remission. Self-admission to psychiatric inpatient treatment is an innovative collaborative approach to healthcare rationing in which patients with a history of high utilization of inpatient treatment are offered the choice to decide for themselves when a brief hospital admission episode—

Methods

Results

Discussion

Conclusion