TY - JOUR

T1 - Assessing a financial incentive for reducing length of stay of psychiatric inpatients

T2 - Implications for financing psychiatric services

AU - Warnke, Ingeborg

AU - Rössler, Wulf

AU - Nordt, Carlos

AU - Herwig, Uwe

PY - 2014/8/7

Y1 - 2014/8/7

N2 - QUESTIONS UNDER STUDY: Restricted government budgets are forcing countries to implement more efficient health measures. Unlike in somatic medicine, the process of evaluating payment systems in psychiatry in Switzerland is ongoing. A pilot approach in one psychiatric hospital, here called "new remuneration system (NRS)", was introduced to better control length of stay (LOS) by combining a lump sum with degressive daily rates. This is a first evaluation of the NRS in terms of a reduction of the LOS, and the prevention of early readmissions by analysing meaningful outcome categories. METHODS: The total sample consisted of N = 66,626 psychiatric inpatient episodes and a subsample of N = 60,847. Data were collected from the hospital using the NRS and three comparison hospitals in the Canton of Zurich. The observation period covered 2005 to 2011, the years before and after the implementation of the NRS in 2009. To examine the outcome categories, general logistic models were used. RESULTS: The median LOS at all four hospitals was 21 days (IQR: 46-8). In the NRS-hospital, there was a significantly higher proportion of 6 to10-day stays after 2009, indicating an influence of the lumpsum measure. At the same time, data revealed a somewhat lower proportion of readmissions within 30 days in the NRS-hospital. In general, effect sizes were small. CONCLUSIONS: Within the observation period of three years since 2009, the NRS had a small influence on LOS and early readmissions. The stability of effects needs to be monitored. More sophisticated modellings of the NRS might lead to further insights.

AB - QUESTIONS UNDER STUDY: Restricted government budgets are forcing countries to implement more efficient health measures. Unlike in somatic medicine, the process of evaluating payment systems in psychiatry in Switzerland is ongoing. A pilot approach in one psychiatric hospital, here called "new remuneration system (NRS)", was introduced to better control length of stay (LOS) by combining a lump sum with degressive daily rates. This is a first evaluation of the NRS in terms of a reduction of the LOS, and the prevention of early readmissions by analysing meaningful outcome categories. METHODS: The total sample consisted of N = 66,626 psychiatric inpatient episodes and a subsample of N = 60,847. Data were collected from the hospital using the NRS and three comparison hospitals in the Canton of Zurich. The observation period covered 2005 to 2011, the years before and after the implementation of the NRS in 2009. To examine the outcome categories, general logistic models were used. RESULTS: The median LOS at all four hospitals was 21 days (IQR: 46-8). In the NRS-hospital, there was a significantly higher proportion of 6 to10-day stays after 2009, indicating an influence of the lumpsum measure. At the same time, data revealed a somewhat lower proportion of readmissions within 30 days in the NRS-hospital. In general, effect sizes were small. CONCLUSIONS: Within the observation period of three years since 2009, the NRS had a small influence on LOS and early readmissions. The stability of effects needs to be monitored. More sophisticated modellings of the NRS might lead to further insights.

KW - Psychology

KW - Early readmissions

KW - Inpatient psychiatry

KW - Length of stay

KW - Remuneration system

KW - Early readmissions

KW - Inpatient psychiatry

KW - Length of stay

KW - Remuneration system

UR - http://www.scopus.com/inward/record.url?scp=84907326335&partnerID=8YFLogxK

U2 - 10.4414/smw.2014.13991

DO - 10.4414/smw.2014.13991

M3 - Journal articles

C2 - 25101764

AN - SCOPUS:84907326335

VL - 144

JO - Swiss Medical Weekly

JF - Swiss Medical Weekly

SN - 1424-7860

M1 - w13991

ER -