Abstract
Length-of-stay (LOS) for inpatient mental health care is a major driver of variation in resource use internationally. We explore determinants of LOS in England, focusing on the impact of emergency readmission rates which can serve as a measure of the quality of care. Data for 2009/2010 and 2010/2011 are analysed using hierarchical and non-hierarchical models. Unexplained residual variation among providers is quantified using Empirical Bayes techniques. Diagnostic, treatment and patient-level demographic variables are key drivers of LOS. Higher emergency readmission rates are associated with shorter LOS. Ranking providers by residual variation reveals significant differences, suggesting some providers can improve performance.
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Notes
From April 1, 2013 PCTs ceased to exist and were replaced by Clinical Commissioning Groups (CCGs) and local area teams (LATs).
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Acknowledgments
An earlier version of this paper was presented at the meeting of the Health Economists Study Group, 8-10 January 2014, Sheffield, UK. We would like to thank Søren Rud Kristensen and session participants for their comments. We would like to thank participants at the Health Econometrics and Data Group seminar at the University of York, 19th June 2013, for feedback. We are also grateful to two anonymous referees for very helpful comments. Hospital Episode Statistics (HES) are Copyright ©1998/1999–2012/2013, re-used with the permission of The Health & Social Care Information Centre. All rights reserved.
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An erratum to this article is available at http://dx.doi.org/10.1007/s10488-016-0720-y.
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Moran, V., Jacobs, R. & Mason, A. Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay. Adm Policy Ment Health 44, 188–200 (2017). https://doi.org/10.1007/s10488-015-0711-4
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DOI: https://doi.org/10.1007/s10488-015-0711-4