Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: A systematic review and meta-analysis

Background: Hospital inpatients often experience medical and psychiatric problems simultaneously. Although this implies a certain relationship between healthcare utilization and costs, this relationship has never been systematically reviewed. Objective: The objective is to examine the extent to which medical-psychiatric comorbidities relate to health-economic outcomes in general and in different subgroups. If the relationship is significant, this would give additional reasons to facilitate the search for targeted and effective treatments for this complex population. Method: A systematic review in Embase, Medline, Psycinfo, Cochrane, Web of Science and Google Scholar was performed up to August 2016 and included cross-references from included studies. Only peer-reviewed empirical studies examining the impact of inpatient medical-psychiatric comorbidities on three health-economic outcomes (length of stay (LOS), medical costs and rehospitalizations) were included. Study design was not an exclusion criterion, there were no restrictions on publication dates and patients included had to be over 18 years. The examined populations consisted of inpatients with medical-psychiatric comorbidities and controls. The controls were inpatients without a comorbid medical or psychiatric disorder. Non-English studies were excluded. Results: From electronic literature databases, 3165 extracted articles were scrutinized on the basis of title and abstract. This resulted in a full-text review of 86 articles: 52 unique studies were i

Evaluation of opening a type III/IV medical psychiatric unit

Objective: The aim of this study is to examine the impact of opening a medical psychiatric unit (MPU) on a variety of outcomes. Methods: In this non-equivalent groups design, there were two groups: ‘pre-MPU’ and ‘actual MPU’. Staff assessed whether patients in the pre-MPU group were eligible for admission to a planned MPU, resulting in virtual admissions and discharges. The actual MPU group consisted of patients admitted after opening of the MPU. Results: The length of stay (LOS) in the hospital was one day longer for patients in the MPU group (8.68 vs. 9.89, p =.004), but the LOS on the MPU was comparable in both groups (5.63 vs. 6.06, p =.231). The LOS on the intensive care unit (ICU) was longer in the MPU group (0.10 vs. 0.40, p <.001), even as the time patients were physically restraint (0.28 vs. 0.83, p <.001). In the pre-MPU group, the odds were not significantly different for involuntary commitment (OR = 0.92; p =.866) and death within six months after discharge (OR = 1.84; p =.196). Conclusions: Both physical restraint and ICU admission have a link with patient complexity, it therefore seemed that opening of the MPU resulted in the treatment of more complex patients with a comparable LOS on the MPU.KEY POINTS The LOS on the MPU was not significantly different between the groups before and after opening of the MPU. Opening of the MPU resulted in the admission of patients that were admitted more days to the ICU and to more days of physically restraint. It can be considered that opening of the MPU resulted in an increased ability to treat complex patients