DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience
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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DOI：
10.1007/s00127-010-0231-1
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发表时间：
2011-07-01
影响因子：
4.4
通讯作者：
Amaddeo, Francesco
中科院分区：
文献类型：
--
作者：
Pertile, Riccardo;Donisi, Valeria;Amaddeo, Francesco
本研究的目的是确定服务相关和基于地区的措施，以及社会人口因素，可以改善诊断相关的群体在解释住院时间的变异性在韦内托地区（意大利东北部）的综合医院精神科。一个分层多元回归模型，只有诊断相关的群体作为预测因素的实际和ln转换的住院时间进行了比较与第二个模型，其中包括患者，服务和地区水平的变量。分层多元回归分析以当地卫生行政区为组水平，单诊断解释实际住院日总方差的6.4%（ln转换为14.8%）。在第二种模式中，住院时间长短还与性别、年龄、住院严重程度、患者所在的地方卫生区、综合医院精神科的精神病医生、心理学家、医院护理人员/护士、社会工作者和教育工作者的人数、每个地方卫生区的门诊病人人数以及离婚和单身人士的百分比有关，在解释方差中，实际住院时间增加了近2%（ln转换增加了5%）。首次使用了韦内托地区所有公立急性住院精神病机构的出院卡区域调查。本研究的创新之处在于，试图调查住院时间与其他指标之间的关系，不仅表征住院设施，而且还表征每个地区的常住人口结构。有关影响住院时间的因素的信息可有助于为服务规划和资源分配提供信息。
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).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.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).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.