Number Of Inpatient Days Research Articles

Resource use associated with type 2 diabetes in Asia, Latin America, the Middle East and Africa: results from the International Diabetes Management Practices Study (IDMPS)

To estimate diabetes-related resource use and investigate its predictors among individuals with type 2 diabetes in 24 countries in Asia, Latin America, the Middle East and Africa. Cross-sectional observational data on diabetes-related resource use were collected from 15,016 individuals with type 2 diabetes within the second wave of International Diabetes Management Practices Study. Mean (SD) annual quantities were determined and predictors of diabetes-related hospitalisations, inpatient days, emergency room visits and absenteeism were investigated using negative binomial regression. Patients in Asia (n = 4678), Latin America (n = 6090) and the Middle East and Africa (n = 4248) made a mean (SD) of 3.4 (6.9), 5.4 (6.7) and 2.5 (4.4) General Practitioner visits per year. The mean (SD) number of inpatient days amounted to 3.8 (18.1), 2.2 (13.9) and 2.6 (13.5) per year. Results of the regression analysis showed the major influence of diabetes-related complications and inadequate glycaemic control on resource use. The expected annual rate of hospitalisation of patients with macrovascular complications compared with those without was 4.7 times greater in Asia [incidence rate ratio (IRR) = 4.7, 95% CI: 2.8-7.8, n = 2551], 5.4 times greater in Latin America (IRR = 5.4, 95% CI: 3.0-9.8, n = 3228) and 4.4 times greater in the Middle East and Africa (IRR = 4.4, 95% CI: 2.8-6.9, n = 2630). Micro- and macrovascular complications and inadequate glycaemic control are significant predictors of resource use in people with type 2 diabetes of developing countries. This knowledge confirms the health economic importance of early diagnosis of diabetes, education of patients and glycaemic control.

“What I got from treatment”: Predictors of treatment content received and association of treatment content with 6-month outcomes in adolescents

Some adolescents show a greater response to treatment than others. We examined the extent to which amount of treatment content received was associated with certain patient characteristics (e.g., readiness to change) and severity of substance involvement at 6-month follow-up. Adolescents ( N = 107) recruited from outpatient addiction treatment reported at follow-up on the extent to which treatment addressed addictive behaviors (e.g., getting motivated to change) and other concerns (e.g., depression). Contrary to prediction, readiness to change did not predict amount of treatment content received, but greater number of inpatient days during follow-up predicted greater endorsement of addictive behaviors content. At 6 months, more addictive behaviors content received was associated with fewer alcohol symptoms. For both alcohol and marijuana, greater endorsement of treatment content related to other concerns was associated with greater substance involvement at 6 months, suggesting the importance of evaluating and addressing other concerns because youth may present with problems in multiple domains.

Diferenciais de utilização do cuidado de saúde no sistema suplementar brasileiro

Este artigo investiga os diferenciais de utilização de serviços no sistema de saúde brasileiro a partir de uma análise contrafactual utilizando os dados da Pesquisa Nacional de Amostra Domiciliar de 1998 e 2003. Duas variáveis de utilização do cuidado médico foram selecionadas: consultas médicas e dias de internação. Os resultados sugerem a presença de sobreutilização para os dois tipos de cuidado, mas a magnitude desse diferencial é mais elevada para consultas do que para internações: para consultas, verificamos que os indivíduos que têm plano de saúde utilizam, em média, 25% a mais do que utilizariam se estivessem no sistema de saúde público e, para internações, esse diferencial está no intervalo de 8 a 15%. Para contornar a endogeneidade entre as decisões de ter plano de saúde e de utilização propomos três procedimentos. Os resultados são bastante robustos e estão em consonância com a evidência empírica internacional.

Speed of response to threshold and suprathreshold bilateral ECT in depression, mania and schizophrenia

Background Bilateral electroconvulsive therapy (BLECT) is useful in affective disorders and schizophrenia. Studies on electrical dose during BLECT are sparse. The Royal College of Psychiatrists recommends the use of electrical dose at 50–100% above seizure threshold. We studied the impact of change of BLECT practice from using threshold-level to 1.5 times threshold-level electrical dose in patients with depression, mania and schizophrenia. Method Data of 100 consecutive inpatients who received BLECT at threshold-level was compared with that of 101 who received BLECT at 1.5 times threshold-level. Patients in the two groups were comparable in sociodemographic and clinical details. In all patients ECT was stopped after patients had shown clinical improvement. Number of ECTs required to achieve improvement and the number of inpatient days after the start of ECT formed the outcome measures. Results Overall, there was no significant difference between the groups in the outcome variables. However, when diagnoses were considered separately, patients with mania who received threshold-level needed about 2 more ECT sessions ( t = 2.6; p = 0.01) and stayed for about 10 more days as inpatients ( t = 2.4; p = 0.03) than those who received 1.5 times threshold-level BLECT. Limitations The study is chart-based, with its inherent limitations. Standard outcome measures were not used. Cognitive adverse effects were not studied. Conclusions Patients with schizophrenia and depression treated with BLECT at 1.5 times threshold-level electrical stimulus require similar number of ECT sessions as with threshold-level. However, patients with mania show clinical improvement with significantly fewer ECT sessions if treated at suprathreshold stimulus.

Outcomes of Staphylococcus aureus Infection in Hemodialysis-Dependent Patients

Staphylococcus aureus is a leading cause of infection in patients with ESRD. Clinical and economic outcomes associated with S. aureus bacteremia and other S. aureus infections in patients with ESRD were examined. Laboratory, clinical, and hospital billing data from a randomized trial of 3359 hemodialysis-dependent patients hospitalized with S. aureus infection in the United States whose vascular access type was fistula or graft and who were hospitalized with S. aureus infection to evaluate inpatient costs, hospital days, and mortality over 12 wk were used. Generalized linear regression was used to identify independent predictors of 12-wk costs, inpatient days, and mortality. Of the 279 patients (8.3%) who developed S. aureus infection during approximately 1 yr of follow-up, 25.4% were treated as outpatients. Among patients for whom billing data were available, 89 patients hospitalized with S. aureus bacteremia incurred mean 12-wk inpatient costs of $19,454 and 11.9 inpatient days. Among the 70 patients hospitalized with non-bloodstream S. aureus infections, mean inpatient costs were $19,222 and the mean number of inpatient days was 11.3. Twelve-week mortality was 20.2 and 15.7% for patients with S. aureus bloodstream and non-bloodstream infections, respectively. Older age was independently associated with higher risk of death among patients with S. aureus bacteremia and with higher inpatient costs and more hospital days among patients with non-bloodstream infections. Hemodialysis-dependent patients with fistula or graft access incur high costs and long inpatient stays when hospitalized for S. aureus infection.

The Economic Burden of Chemotherapy-Induced Toxicity in Lymphoma and NSCLC Routine Hospital Care

The majority of chemotherapy (CT) patients (pts) receive care outside of clinical trial settings. In contrast little is known about the economic consequences of CT-induced toxicity in routine care. This was a prospective, multi-centre, observational, longitudinal cost-of-illness study. Lymphoma and non small cell lung cancer (NSCLC) pts were enrolled consecutively from 1/2005–12/2006 at the start of first or second line (immuno) CT treatment in 4 German hospitals. Patients receiving myeloablative CT with peripheral blood stem cells were excluded. Clinical data and resource use were collected from pre-planned chart reviews. German tariffs & prices in €2007 and hospital databases were used to allocate costs to health care resources. Toxicity related costs are presented from the hospital provider perspective. 273 pts undergoing 286 treatment courses with a total of 1004 CT-cycles were evaluable. 153 pts had lymphoma (47% of courses were CHOP-like) and 120 NSCLC (78% of courses were platinum-based). Mean age was 60.1 years (SD 13.0); age≥65 years 40%; female 36%; ECOG≥2 11%; tumour stage≥3 56%; history of co-morbidity 80%. The table shows a comparison of lymphoma and NSCLC patient characteristics. 208 of treatment courses (73%) were associated with at least one hospital stay (lymphoma 69%, NSCLC 78%). Mean±SD number of inpatient days was 13.1±17.7 (lymphoma 13.5±20.7, NSCLC 12.8±14.0). Mean (median) toxicity related costs amounted to€3,624 (€1,035) per treatment course with€3,366 (€1,406) for NSCLC and€3,838 (€684) for lymphoma. 8% of CT-courses (lymphoma n=12, NSCLC n= 11) were associated with costs ≥€10,000 and accounted for 50% of total expenses. In this high cost group mean toxicity associated costs nearly doubled for lymphoma pts (lymphoma€28,607, NSCLC€15,533). Hospital basic services and personnel represented 74% of total costs (lymphoma 70%, NSCLC 80%), followed by expenses for drugs (lymphoma 15%, NSCLC 9%). Our findings highlight that toxicity management in NSCLC and lymphoma pts induces significant resource use and associated costs. Cost drivers are hospitalization and drugs. Frequency distribution of costs is asymmetric with less than 10% of CT-courses contributing to half of total economic burden. Treatment courses with mean toxicity related costs of €10,000 or more are twice as expensive for lymphoma patients as for NSCLC.Lymphoma (n=153)NSCLC (n=120)Age: mean (SD)58.2 (15.4)63.0 (8.4)Age ≥ 6558 (38%)52 (43%)Male99 (65%)77 (64%)ECOG≥210 (7%)20 (17%)Tumour stage ≥372 (47%)102 (85%)History of co-morbidity107 (70%)112 (93%)

The Cost of Medical Management in Advanced Heart Failure During the Final Two Years of Life

Objective To examine patterns of resource use and the cost of care for patients with advanced heart failure treated with medical management (MM) during the final 2 years of life. Methods and Results The study population (n = 47, mean age 70.4 years ± 7.06) included patients randomized to the MM arm of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. Inpatient and outpatient use data were obtained from the clinical dataset and Centers for Medicare and Medicaid Services (beginning January 1, 1998). Cost and resource use were tracked from the date of death (t d) backward in 3-month intervals (eg, t d-1, t d-2). In the primary analysis, costs were summed across intervals. The mean cost of MM in the final 2 years of life was $156,169, with 50.5% ($78,880.39) expended in the final 6 months. The mean quarterly cost increased ( P < .01) 4.9-fold from t d-8 ($8,816 ± $14,270) to t d-1 ($42,836 ± $41,407). The number of inpatient days increased ( P < .01) 6.6-fold from 3.8 ± 4.7 days to 22.2 ± 23.5 days during the same time intervals. Conclusion This current economic analysis extends on previous findings by demonstrating that medical therapy in advanced and end-stage heart failure is associated with significant costs and resource consumption; these costs and resource consumption increase significantly as death approaches.

Gerald Shulman digests his award

Gerald Shulman digests his award

Resource use and costs of type 2 diabetes in Sweden - estimates from population-based register data

To examine medical resource use of Swedish patients with type 2 diabetes during 2000-2004 and to estimate annual costs of care. Retrospective population-based cohort study of patients with type 2 diabetes identified in computerised medical records at 26 primary care centres in Uppsala county, Sweden. Annual quantities of medical resources were determined for prevalent cases during 2000-2004 using register data from outpatient primary care, outpatient hospital care, the National Inpatient Register and a national register for treatment of uraemia. Average costs of care of patients with type 2 diabetes were estimated based on year 2004 resource quantities of 8230 prevalent study cases. Annual quantities of medical resource use were stable in outpatient primary care and outpatient hospital care, with patients making an average of two General Practitioner visits and 3.5 outpatient hospital visits each year. Higher rates of hospitalisation [12% in 2000 (n = 6711) compared with 16% in 2004 (n = 8230)] led to an increase in the mean (SD) number of inpatient days from 2.3 (11.8) to 2.7 (11.9) (p = 0.040) between 2000 and 2004. Mean (SD) total costs of care in 2004 were EUR 3602 (EUR 9537). Inpatient care was the major contributor to costs, accounting for 57% of total costs while drug costs accounted for an average 7%. Swedish type 2 diabetic patients in this large sample from Uppsala county required steady annual amounts of outpatient care and increasing amounts of inpatient care during 2000-2004. The associated costs in 2004 were substantial, with inpatient care identified as the most important component.

Datapoints: Inpatient Utilization for Persons With Co-occurring Disorders

14 P with co-occurring mental and substance use disorders have been shown to be frequent users of inpatient care (1). Such studies, however, are limited to a single funding stream, type of disorder, or locale. Given recent emphasis on improving care for people with such co-occurring disorders, better estimates of inpatient utilization are important to aid design of effective, efficient public mental health and substance abuse services. This column describes use of inpatient care in Delaware, Oklahoma, and Washington by clients who received at least one mental health or substance abuse service from the state mental health, substance abuse, or Medicaid agency in calendar year 1997 (2). Administrative files of these clients were matched across those agencies and categorized into three diagnostic groups: mental disorder only, substance use disorder only, and co-occurring mental and substance use disorders. Results were expected to differ across states because of potential differences in the case mix of patients served, types and amounts of services supported, regional variation in clinical practice, population dispersion and density, organization of each state authority administering services, managed care involvement, total dollars devoted to such services, and other factors. Clients with co-occurring disorders were three to four times more likely to be hospitalized than clients with mental illness only and ten to 20 times more likely to be admitted than clients with a substance use disorder only. The average number of inpatient days per admitted client differed across states by more than 100% for each diagnostic group (Figure 1). Despite the divergence in absolute values across states, in each state the length of inpatient stays were longest for admitted clients with mental illness only, followed by those with co-occurring disorders and those with a substance use disorder only. Yet across all clients, not just those admitted, the annual average number of hospital days per group was highest for the group with co-occurring disorders (data not shown). Further study is needed to assess factors associated with higher admission rates for clients with co-occurring mental and substance use disorInpatient Utilization for Persons With Co-occurring Disorders

Datapoints: Inpatient Utilization for Persons With Co-occurring Disorders

People with co-occurring mental and substance use disorders have been shown to be frequent users of inpatient care (1). Such studies, however, are limited to a single funding stream, type of disorder, or locale. Given recent emphasis on improving care for people with such co-occurring disorders, better estimates of inpatient utilization are important to aid design of effective, efficient public mental health and substance abuse services. This column describes use of inpatient care in Delaware, Oklahoma, and Washington by clients who received at least one mental health or substance abuse service from the state mental health, substance abuse, or Medicaid agency in calendar year 1997 (2). Administrative files of these clients were matched across those agencies and categorized into three diagnostic groups: mental disorder only, substance use disorder only, and co-occurring mental and substance use disorders. Results were expected to differ across states because of potential differences in the case mix of patients served, types and amounts of services supported, regional variation in clinical practice, population dispersion and density, organization of each state authority administering services, managed care involvement, total dollars devoted to such services, and other factors. Clients with co-occurring disorders were three to four times more likely to be hospitalized than clients with mental illness only and ten to 20 times more likely to be admitted than clients with a substance use disorder only. The average number of inpatient days per admitted client differed across states by more than 100% for each diagnostic group (Figure 1). Despite the divergence in absolute values across states, in each state the length of inpatient stays were longest for admitted clients with mental illness only, followed by those with co-occurring disorders and those with a substance use disorder only. Yet across all clients, not just those admitted, the annual average number of hospital days per group was highest for the group with co-occurring disorders (data not shown). Further study is needed to assess factors associated with higher admission rates for clients with co-occurring mental and substance use disor

Editorial: Obesity Is A Spreading Modern Life Health Problem

In the current issue of IJ Health there are two aeticles assewsing obesity in children and the economic of medical treatment of sequences of obesity [1, 2]. Obesity is considered one of the fastest growing epidemics of the developed world, which is also spreading to the developing countries. Currently, in the United States, about 127 million adults are overweight, 60 million are obese, and nine million are severely obese [3]. Obesity increases risk for a variety of diseases. Hence, prevention of obesity is an essential responsibility of public health, not only because of its association with diseases, but also because of the economic implications and predisposition to co-morbidities. Obesity is a very significant risk factor for Coronary Artery Disease (CAD), which can lead to myocardial infarction. Obesity is associated with hypertension, high triglycerides, and high LDL cholesterol levels, which indeed are major risk factors for the CAD and stroke. It also results in lowering of cardioprotective HDL levels. However, heart disease and stroke reflect only the tip of the iceberg. [1] Since obesity is now identified as a global health problem in both developed and developing countries. Japan is not an exception. [2] investigation observing the change in the proportion of obese individuals in Japanese adults from 1976 to 1995, found that the body mass index (BMI) in men increased by 0.44 over a period of 10 years. The Examination Committee of Criteria for Obesity Disease in Japan, the Japan Society for the Study of Obesity, specifies lipid metabolism disorders and diabetes mellitus as health problems caused by or related to obesity requiring weight loss. It is also known that the incidence of health problems increases as the degree of obesity increases. The National Health and Nutrition Examination Surveys (NHANES) I to III and showed that increased BMI was associated with an increased incidence of obesity-related disorders. The National Institutes of Health also indicates that the incidence of low HDL cholesterolemia and hypertension is markedly higher in individuals with a BMI of 30 or more [2] Association of the degree of obesity and health problems has direct implication for medical costs. The relationship between the degree of obesity and annual medical costs, number of inpatient days was recently reported, number of outpatient visits, and medication costs in members of a health maintenance organization in the United States. Compared with individuals with a BMI of 20 to 24.9, annual medical costs were 25% greater in individuals with a BMI of 30 to 34.9 and 44% greater in those with a BMI of 35 or more. Those medical costs increased in individuals with higher BMI in the United States and in Australia. Similar results in Japanese individuals were reported. Compared with individuals with a BMI of 21.0 to 22.9, total medical costs were 1.10 times greater in overweight individuals with a BMI of 25 to 29.9 and 1.22 times greater in obese individuals with a BMI of 30 or more, indicating increased total medical costs with increasing BMI. These studies did not focus on obesity-related disorders such as hyperlipidemia or estimate the impact of obesity on total medical costs [2]. In Japan, only one anti-obesity drug is now covered by national health insurance, and reimbursement is based on a very strict criterion of BMI of 35 or more. However, analysis of the relationship between BMI and medical costs of obesity-related disorders is very important in the context of multiple anti-obesity drugs under clinical development in Japan, possibility of review of the criteria for health insurance coverage of the anti-obesity drug, and an increase in the number of obese individuals. Editorial: Obesity Is A Spreading Modern Life Health Problem 2 of 3 The present Paper [2] focused on the medical costs of hyperlipidemiadepending on d ata from the National Health and Nutrition Survey were used to determine the percentage of individuals with hyperlipidemia among those with a risk factor of BMI equal to or greater than a certain level. This paper results imply that change in the BMI-based criteria for obesity is associated with a substantial increase or decrease in avoidable medical costs of hyperlipidemia.

Impact of Fatty Liver Disease on Health Care Utilization and Costs in a General Population: A 5-Year Observation

Fatty liver disease is a common condition in the Western world. Fatty liver may progress to steatohepatitis and cirrhosis. It is not yet known whether fatty liver disease results in higher health care utilization and costs. We used data from the Study of Health in Pomerania (SHIP), Germany, to assess the relation of fatty liver disease to self-reported health care utilization and costs at baseline and 5 years. The SHIP is a general population cohort study of 4310 adults aged 20 to 79 years at baseline in Pomerania. Fatty liver disease was defined as the presence of a hyperechogenic pattern of the liver and elevated serum alanine aminotransferase (ALT) levels. In multivariable analyses, average annual overall health care costs at baseline and follow-up measurement were significantly higher for individuals with sonographic fatty liver and increased serum ALT levels. For example, controlling for comorbid conditions, subjects with sonographic fatty liver disease and increased serum ALT levels had 26% higher overall health care costs at 5-year follow-up. Analyses also suggest that diabetes and cardiovascular disease might mediate the relation of fatty liver disease and health care utilization and costs. Policies seeking to minimize costs associated with fatty liver disease might want to consider addressing behavioral risk factors of fatty liver disease.

Diagnostic Classifications and Resource Utilization of Decedents Served by the Department of Veterans Affairs

Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA). A retrospective computerized record review was conducted of 20,933 VHA patients who died as inpatients between October 1, 2001 and September 30, 2002. Diagnoses were aggregated into one of five classification patterns of death and analyzed in terms of health care resource utilization (mean number of inpatient days and cumulative outpatient visits in the year preceding the patient's death). Cancer deaths were the most common (30.4%) followed by end-stage renal disease (ESRD) (23.2%), cardiopulmonary failure (21.4%), frailty (11.6%), "other" diagnoses (7.3%), and sudden deaths (6.1%). Those with ESRD were more likely to be male and nonwhite (p < 0.05) and those with frailty were more likely to be older and married (p < 0.05). Controlling for demographic variables, those with frailty had the highest number of inpatient days while those with ESRD had the highest number of outpatient visits. Non-married status was associated with more inpatient days, especially among younger decedents. As a recognized leader in end-of-life care, the VHA can play a unique role in the development of specific interventions that address the diverse needs of persons with different dying trajectories identified through this research.

Health and social service use among old people in the last 2years of life.

This study focuses on differences in health and social service use in the last 2years of life among Finnish people aged 70-79, 80-89, and 90 or older and on the variation in service use in the various municipalities. The data set, derived from multiple national registers, consists of 75,578 people who died in 1998-2001. The services included hospitals and long-term-care facilities, use of regular home care, and prescribed medicines. General hospital and public long-term care were the services most commonly used: general hospitals for younger age groups and public long-term care for older groups. The number of inpatient days in hospital was lower with increasing age, but older age groups used long-term care more frequently. Men had more hospital inpatient days than women, but women used more long-term care. The number of hospital inpatient days increased rapidly in the last months of life, almost doubling in the final month. Days in public long-term care increased regularly in the last 2years of life. Variation in both hospital and long-term care by municipality was remarkable. The results indicate that, among people aged 70years and older, age is a major determinant of care in the last 2years of life. The variation in the use of care by municipality and the differences between men and women deserve more detailed analysis in future.

Backyard burning

This study was undertaken to determine whether changes had occurred in the numbers of burns that could be related to backyard burning subsequent to the introduction of the council tax throughout Eire for the collection of household refuse. Numbers of patients admitted to our unit who had sustained burns by burning rubbish were recorded prospectively over a period of 12 months. A random control group was taken as three years prior to this and results found by retrospective chart review. Between January and November 2005, 168 patients were admitted to the National Burns Unit, St James's Hospital Dublin, Ireland. Nineteen of these patients sustained flame burns from backyard burning. One hundred and seventy patients were admitted in the comparative period of 2002; Seven of these from backyard burning. The total number of inpatient days for these patients in 2005 (255) was significantly more than in 2002 (68) (p=0.024). The numbers in our study show a marked increase in the number of patients sustaining burns in this manner, and appear to correlate with the introduction of bin charges by a number of county councils around the country last year. This study demonstrates that the introduction of legislation can have an unforeseen adverse affect on the population if not introduced in correlation with appropriate public education. While the introduction of waste charges represents a very necessary move forward in waste disposal in Ireland, public awareness campaigns should be implemented to prevent further such injuries from occurring.

Changing Pattern of Adult Burn Referrals to a Regional Burns Centre

The National Burn Care Review prompted us to review trends in adult acute admissions to our unit with the intention to implement the guidelines of referral set down in the report. We had recently also adopted a more open admissions policy in keeping with these recommendations. This was achieved by a retrospective casenote analysis with the years 1981, 1991, and 2001 used as reference snapshot years to outline trends. The results showed an increase in the number of patients, a decrease in the depth and extent of burns, a decrease in the number of inpatient days and crude mortality rate. There was also a slight decrease in the age of patients.

Trends in the Inpatient Mental Health Treatment of Children and Adolescents in US Community Hospitals Between 1990 and 2000

Previous work has demonstrated marked changes in inpatient mental health service use by children and adolescents in the 1980s and early 1990s, but more recent, comprehensive, nationally representative data have not been reported. To describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000. Analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationally representative sample of discharges from US community hospitals sponsored by the Agency for Healthcare Research and Quality. Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder. Changes in the number and population-based rate of discharges, total inpatient days and average length of stay, charges, diagnoses, dispositions, and patient demographic and hospital characteristics. Although the total number of discharges, population-based discharge rate, and daily charges did not significantly change between 1990 and 2000, the total number of inpatient days and mean charges per visit each fell by approximately one half. Median length of stay declined 63% over the decade from 12.2 days to 4.5 days. Declines in median and mean lengths of stay were observed for most diagnostic categories and remained significant after controlling for changes in background patient and hospital characteristics. Discharge rates for psychotic and mood disorders as well as intentional self-injuries increased while rates for adjustment disorders fell. Discharges to short-term, nursing, and other inpatient facilities declined. The period between 1990 and 2000 was characterized by a transformation in the length of inpatient mental health treatment for young people. Community hospitals evaluated, treated, and discharged mentally ill children and adolescents far more quickly than 10 years earlier despite higher apparent rates of serious illness and self-harm and fewer transfers to intermediate and inpatient care.

Factors in the Selection of Patients for Conditional Release From Their First Psychiatric Hospitalization

Factors in the Selection of Patients for Conditional Release From Their First Psychiatric Hospitalization

Whole life cycle performance measurement re‐engineering for the UK National Health Service estate

PurposeThe measurement of the performance of built assets with the UK National Health Service portfolio is based on simple benchmarking techniques such as £/m2. The purpose of this paper is to examine an alternative approach, which could produce a more informed and balanced approach to performance measurementDesign/methodology/approachThe existing benchmarking and clustering techniques used within the NHS are examined. These reveal inadequacies in truly representing asset performance. Data envelopment analysis techniques are applied here to map the estate costs against the outputs of the estate (i.e. number of inpatient days). Operational and maintenance cost data was collated from 15 NHS acute teaching trusts outside of London, these were mapped against two outputs (in‐patient days and occupied beds per available beds) in order to determine how effectively each NHS Trust translates input resources into inpatient days and occupancy of available beds.FindingsThe results from the models generate efficiency improvement scores. The scores disclose that the standard deviation of average efficiency in the cluster was 22.38, thus revealing a significant variance in performance. The efficiency values range between 100 and 33.6 per cent. The results provide useful information on the technical efficiency of building assets and allow NHS Trusts to identify where efficiency improvements are necessary within a continuous efficiency analysis framework.Research limitations/implicationsFurther work is required on the analysis of other types of hospital buildings within the UK to test the validity of the sample used. Other outputs may also be relevant and should be explored.Practical implicationsThis paper was presented to NHS Estates as part of a commissioned report which is now being considered as part of a process to re‐engineer performance measurement within the estate.Originality/valueThe paper adds value in demonstrating the benefits of an established methodology within a new setting, which is the performance of built assets