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DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience

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Abstract

Purpose

This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy).

Methods

Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis.

Results

The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient’s local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation).

Conclusions

For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.

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Acknowledgments

We are grateful to the Fondazione Cariverona, who provided a 3-year Grant to the WHO Collaborating Centre for Research and Training in Mental Health and Service Organization at the University of Verona, directed by Professor Michele Tansella. The Grant (“Promoting research to improve quality of care. The Verona WHO Centre for mental health research”) started on March 2007 and aims to support the main research projects of the following Units of the Verona WHO Centre: Psychiatric Case Register, Geographical Epidemiology and Mental Health Economics (Head, Professor Francesco Amaddeo); Clinical Psychopharmacology and Drug Epidemiology (Head, Dr. Corrado Barbui); Environmental, Clinical and Genetic Determinants of Outcome of Mental Disorders (Head, Professor Mirella Ruggeri).

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Authors and Affiliations

  1. Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy

    Riccardo Pertile, Valeria Donisi, Laura Grigoletti, Grazia Zulian & Francesco Amaddeo

  2. Local Health District N. 9 (Treviso), Veneto Region, Treviso, Italy

    Andrea Angelozzi

  3. Regional Health Information System, Veneto Region, Venezia, Italy

    Giuseppe Zamengo

Authors
  1. Riccardo Pertile
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  2. Valeria Donisi
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  3. Laura Grigoletti
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  4. Andrea Angelozzi
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  5. Giuseppe Zamengo
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  6. Grazia Zulian
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  7. Francesco Amaddeo
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Correspondence to Riccardo Pertile.

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Pertile, R., Donisi, V., Grigoletti, L. et al. DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience. Soc Psychiatry Psychiatr Epidemiol 46, 651–660 (2011). https://doi.org/10.1007/s00127-010-0231-1

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  • DOI: https://doi.org/10.1007/s00127-010-0231-1

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