Analysis of hospital costs by morbidity group for patients with severe mental illness

Objectives: The goal of this study is to analyse hospital costs and length of stay of patients admitted to psychiatric units in hospitals in a European region of the Mediterranean Arc. The aim is to identify the effects of comorbidities and other variables in order to create an explanatory cost model. Methods: In order to carry out the study, the Ministry of Health was asked to provide data on access to the mental health facilities of all hospitals in the region. Among other questions, this database identifies the most important diagnostic variables related to admission, like comorbidities, age and gender. The method used, based on the Manning-Mullahy algorithm, was linear regression. The results were measured by the statistical significance of the independent variables to determine which of them were valid to explain the cost of hospitalization. Results: Psychiatric inpatients can be divided into three main groups (psychotic, organic and neurotic), which have statistically significant differences in costs. The independent variables that were statistically significant (p <.05) and their respective beta and confidence intervals were: psychotic group (19,833.0 ± 317.3), organic group (9,878.4 ± 276.6), neurotic group (11,060.1 ± 287.6), circulatory system diseases (19,170 ± 517.6), injuries and poisoning (21,101.6 ± 738.7), substance abuse (20,580.6 ± 514, 6) and readmission (19,150.9 ± 555.4). Conclusions: Unlike most health services, access to psychiatric facilities does not correlate with comorbidities due to the specific nature of this specialization. Patients admitted to psychosis had higher costs and a higher number of average stays

Analysis of hospital costs by morbidity group for patients with severe mental illness

[EN] Objectives The goal of this study is to analyse hospital costs and length of stay of patients admitted to psychiatric units in hospitals in a European region of the Mediterranean Arc. The aim is to identify the effects of comorbidities and other variables in order to create an explanatory cost model. Methods In order to carry out the study, the Ministry of Health was asked to provide data on access to the mental health facilities of all hospitals in the region. Among other questions, this database identifies the most important diagnostic variables related to admission, like comorbidities, age and gender. The method used, based on the Manning-Mullahy algorithm, was linear regression. The results were measured by the statistical significance of the independent variables to determine which of them were valid to explain the cost of hospitalization. Results Psychiatric inpatients can be divided into three main groups (psychotic, organic and neurotic), which have statistically significant differences in costs. The independent variables that were statistically significant (p <.05) and their respective beta and confidence intervals were: psychotic group (19,833.0 +/- 317.3), organic group (9,878.4 +/- 276.6), neurotic group (11,060.1 +/- 287.6), circulatory system diseases (19,170 +/- 517.6), injuries and poisoning (21,101.6 +/- 738.7), substance abuse (20,580.6 +/- 514, 6) and readmission (19,150.9 +/- 555.4). Conclusions Unlike most health services, access to psychiatric facilities does not correlate with comorbidities due to the specific nature of this specialization. Patients admitted to psychosis had higher costs and a higher number of average stays KEY MESSAGES The highest average hospital expenditure occurred in patients admitted for psychotic disorders. Due to the particularities of psychiatry units and unlike other medical specialties, the number of comorbidities did not influence the number of hospital stays or hospital expenditure. Apart from the main diagnostic group, the variables that were useful to explain hospital expenditure were the presence of poisoning and injuries as comorbidity, diseases of circulatory system as comorbidity, history of substance abuse and readmission.Caballer-Tarazona, V.; Zúñiga-Lagares, A.; Reyes Santia, F. (2022). Analysis of hospital costs by morbidity group for patients with severe mental illness. Annals of Medicine. 54(1):858-866. https://doi.org/10.1080/07853890.2022.204888485886654

Perceived needs and health-related quality of life in people with schizophrenia and metabolic syndrome : a "real-world" study

The complexity of schizophrenia lies in the combination of psychiatric, somatic and social needs requiring care. The aim of the study was to compare perceived needs between groups with absence/presence of metabolic syndrome (MetS) and to analyze the relationship between needs, health-related quality of life (HRQoL) and MetS in people with schizophrenia or schizoaffective disorder. A "real-world" cross-sectional study was set up with a comprehensive framework including the following, needs for care (Camberwell Assessment of Need Interview [CAN]), HRQoL (Euro Qol-5D Questionnaire), sociodemographic data, lifestyle habits, psychopathology (Positive And Negative Syndrome Scale [PANSS]), global functioning (Global Assessment of Functioning Scale [GAF]), anthropometric measurements and blood test results were assessed for an outpatient sample (n = 60). The mean number of needs (given by CAN) was identified for both groups. Patients with MetS rated a higher number of needs compared to the group without this condition. Mobility problems (given by EQ-5D) were negatively associated with the number of total and unmet needs. For participants with MetS, HRQoL was related to the number of needs and unmet needs. For people with MetS, positive symptomatology score (given by PANSS) was related to the number of needs and met needs and general symptomatology was associated with total, met and unmet needs. For individuals without MetS, the global functioning score (given by GAF) was significantly inversely related with total, met and unmet needs. Needs and HRQoL, as well as general symptomatology, were related only in patients with MetS. This has implications for treatment planning at the individual and organizational levels. An analysis of both physical and mental needs could provide a starting point for the extension of facilities in the health care system in order to reach the goal of improving quality of life

Estudio de la casuistica en un centro de salud mental comunitario: gravedad y utilizacion de servicios

No hemos encontrado en la literatura psiquiátrica examinada, estudios de casuística psiquiátrica ambulatoria en los que se haya evaluado su complejidad y gravedad con índices de carga asistencial, así como tampoco ningún estudio donde se clasifique esta casuística ambulatoria basado en variables predictivas de utilización de servicios. La mayor parte de la literatura examinada está relacionada con estudios de altas hospitalarias, aplicando las clasificaciones basadas en los GRD. La gravedad en la clínica psiquiátrica es un concepto poco estudiado y también una realidad clínica difícil de definir, delimitar, describir y calibrar. Hasta ahora, la forma más habitual de definirla se ha basado en la intensidad y la cualidad de los síntomas, así como en su impacto psicosocial (discapacidad). La gravedad de los trastornos mentales se ha estudiado principalmente en relación con trastornos con peor pronóstico, como la esquizofrenia, y en estudios de seguimiento desde unidades hospitalarias, pero no tanto en estudios ambulatorios y en una perspectiva general y comparativa de toda la gama de pacientes psiquiátricos ambulatorios. El Case-Mix o perfil del casos, es un constructo de uso creciente en el campo de la gestión de la salud y una nueva forma de clasificar a los pacientes en la medicina general, de acuerdo con su gravedad, las pautas de gestión clínica, el tratamiento y el consumo de servicios. Hemos abordado en el presente trabajo, y desde la perspectiva del Case-Mix, un sistema de clasificación de pacientes psiquiátricos ambulatorios, basado en escalas de gravedad psiquiátrica y de disfunción psicosocial.We have not found in the psychiatric literature examined, studies of outpatient psychiatric casuistry in which the complexity and severity of it have been evaluated with rates of care burden. We have not found any studies to classify this ambulatory casuistry based on predictive variables of service utilization. Most of the literature examined is related to studies of hospital discharges, applying the classifications based on the GRDs. Gravity in the Psychiatric Clinic is a concept little studied and also a clinical reality difficult to define, delimit, describe and calibrate. Until now, the most usual way to define it has been based on the intensity and quality of the symptoms, as well as their psychosocial impact (disability). The severity of mental disorders has been studied mainly in relation to disorders with worse prognosis such as schizophrenia, and in follow-up studies from hospital units, but not so much in outpatient studies and in a general and comparative perspective of all the range of outpatient psychiatric pathology. The Case Mix or Case Profile, is a construct of increasing use in the field of health management and is a new way of classifying patients in the general medical field, according to their severity, clinical management guidelines and treatment or consumption of services. We have addressed in the present work, and from the perspective of the Case-Mix, a classification system of ambulatory psychiatric patients, based on scales of psychiatric severity and psychosocial dysfunction

Estudio de la casuistica en un centro de salud mental comunitario : gravedad y utilizacion de servicios /

No hemos encontrado en la literatura psiquiátrica examinada, estudios de casuística psiquiátrica ambulatoria en los que se haya evaluado su complejidad y gravedad con índices de carga asistencial, así como tampoco ningún estudio donde se clasifique esta casuística ambulatoria basado en variables predictivas de utilización de servicios. La mayor parte de la literatura examinada está relacionada con estudios de altas hospitalarias, aplicando las clasificaciones basadas en los GRD. La gravedad en la clínica psiquiátrica es un concepto poco estudiado y también una realidad clínica difícil de definir, delimitar, describir y calibrar. Hasta ahora, la forma más habitual de definirla se ha basado en la intensidad y la cualidad de los síntomas, así como en su impacto psicosocial (discapacidad). La gravedad de los trastornos mentales se ha estudiado principalmente en relación con trastornos con peor pronóstico, como la esquizofrenia, y en estudios de seguimiento desde unidades hospitalarias, pero no tanto en estudios ambulatorios y en una perspectiva general y comparativa de toda la gama de pacientes psiquiátricos ambulatorios. El Case-Mix o perfil del casos, es un constructo de uso creciente en el campo de la gestión de la salud y una nueva forma de clasificar a los pacientes en la medicina general, de acuerdo con su gravedad, las pautas de gestión clínica, el tratamiento y el consumo de servicios. Hemos abordado en el presente trabajo, y desde la perspectiva del Case-Mix, un sistema de clasificación de pacientes psiquiátricos ambulatorios, basado en escalas de gravedad psiquiátrica y de disfunción psicosocial.We have not found in the psychiatric literature examined, studies of outpatient psychiatric casuistry in which the complexity and severity of it have been evaluated with rates of care burden. We have not found any studies to classify this ambulatory casuistry based on predictive variables of service utilization. Most of the literature examined is related to studies of hospital discharges, applying the classifications based on the GRDs. Gravity in the Psychiatric Clinic is a concept little studied and also a clinical reality difficult to define, delimit, describe and calibrate. Until now, the most usual way to define it has been based on the intensity and quality of the symptoms, as well as their psychosocial impact (disability). The severity of mental disorders has been studied mainly in relation to disorders with worse prognosis such as schizophrenia, and in follow-up studies from hospital units, but not so much in outpatient studies and in a general and comparative perspective of all the range of outpatient psychiatric pathology. The Case Mix or Case Profile, is a construct of increasing use in the field of health management and is a new way of classifying patients in the general medical field, according to their severity, clinical management guidelines and treatment or consumption of services. We have addressed in the present work, and from the perspective of the Case-Mix, a classification system of ambulatory psychiatric patients, based on scales of psychiatric severity and psychosocial dysfunction

Perceived needs and health-related quality of life in people with schizophrenia and metabolic syndrome: a “real-world” study

BACKGROUND: The complexity of schizophrenia lies in the combination of psychiatric, somatic and social needs requiring care. The aim of the study was to compare perceived needs between groups with absence/presence of metabolic syndrome (MetS) and to analyze the relationship between needs, health-related quality of life (HRQoL) and MetS in people with schizophrenia or schizoaffective disorder. METHODS: A “real-world” cross-sectional study was set up with a comprehensive framework including the following, needs for care (Camberwell Assessment of Need Interview [CAN]), HRQoL (Euro Qol-5D Questionnaire), sociodemographic data, lifestyle habits, psychopathology (Positive And Negative Syndrome Scale [PANSS]), global functioning (Global Assessment of Functioning Scale [GAF]), anthropometric measurements and blood test results were assessed for an outpatient sample (n = 60). RESULTS: The mean number of needs (given by CAN) was identified for both groups. Patients with MetS rated a higher number of needs compared to the group without this condition. Mobility problems (given by EQ-5D) were negatively associated with the number of total and unmet needs. For participants with MetS, HRQoL was related to the number of needs and unmet needs. For people with MetS, positive symptomatology score (given by PANSS) was related to the number of needs and met needs and general symptomatology was associated with total, met and unmet needs. For individuals without MetS, the global functioning score (given by GAF) was significantly inversely related with total, met and unmet needs. CONCLUSIONS: Needs and HRQoL, as well as general symptomatology, were related only in patients with MetS. This has implications for treatment planning at the individual and organizational levels. An analysis of both physical and mental needs could provide a starting point for the extension of facilities in the health care system in order to reach the goal of improving quality of life