Abstract
Managed care has emerged as the centerpiece of the health care industry's efforts to control costs and ensure appropriate use of hospital services. This study assesses the impact of managed care by preadmission approval and/or continued stay review on length of psychiatric hospitalization and clinical outcome of children and adolescents. The sample included 277 cases hospitalized in nine psychiatric specialty hospitals in 1990. Demographic and clinical characteristics, hospital ownership type, and preadmission approval or continued stay review were used as independent variables in a multiple regression model to predict length of stay and clinical outcome. Results indicate that the model accounted for 27% of the variance in length of stay. Previous psychiatric hospitalization and for-profit hospital status predicted longer hospitalization. Clinical outcome was not significantly predicted by the model. Managed care did not predict either length of stay or clinical outcome. Implications for health care reform are discussed.
Similar content being viewed by others
References
Tuma JM: Mental health services for children: The state of the art,American Psychologist 1989; 44:188–199.
Knitzer J:Unclaimed Children. Washington, DC: Children's Defense Fund, 1982.
Borenstein DB: Managed care: A means of rationing psychiatric treatment.Hospital and Community Psychiatry 1990; 41:1095–1098.
Krizay J: Industry statistics: Adolescents are major users of inpatient behavioral health services.Open Minds 1988; 1(8):8.
Asay TP, Dimperio TL: Outcome of children treated in psychiatric hospitals. In: Mirin SM, Gossett J, Grob MC (Eds.),Advances in Outcome Research. Washington, DC: American Psychiatric Press, 1991, pp. 21–29.
Blotcky MJ, Dimperio TL, Gossett JT: Follow-up of children treated in psychiatric hospitals: A review of studies.American Journal of Psychiatry 1984; 141:1499–1507.
Gossett JT, Lewis JM, Barnhart FD:To find a way: The outcome of hospital treatment of disturbed adolescents. New York: Brunner/Mazel, 1983.
Dorwart R: Managed mental health care: Myths and realities in the 1990's.Hospital and Community Psychiatry 1990; 41:1087–1091.
Frieman MP, Ellis RP, McGuire T: Provider response to Medicare's PPS: Reductions in length of stay for psychiatric patients treated in scatter beds.Inquiry 1989; 26:192–201.
Rupp A, Steinwachs D, Salkever D: The effect of hospital payment methods on the pattern and cost of mental health care.Hospital and Community Psychiatry 1984; 35:456–459.
Frieman MP, Goldman HH, Taube CA: Hospitalization for psychiatric illness under Medicare, 1985.Hospital and Community Psychiatry 1990; 41:51–58.
Sederer LI, Griffin M, Mirin SM, et al.: Managed Care and Treatment Outcome in Private Psychiatric Hospitals. Unpublished manuscript, McLean Hospital Belmont, MA, 1994.
Strumwasser I, Paranjpe N, Udow M, et al.: Appropriateness of psychiatric and substance abuse hospitalization.Medical Care (Suppl.) 1991; 29(8):S77-S89.
Dickey B, Azeni H: Impact of managed care on mental health services.Health Affairs 1992; 11(3): 197–204.
Gray BH, Field MJ (Eds.):Institute of Medicine Committee on Utilization Management by Third Parties: Controlling Costs and Changing Patient Care? The Role of Utilization Management. Washington, DC, National Academy Press, 1989.
Wickizer TM: The effect of utilization review on hospital use and expenditures: A review of the literature and an update on recent findings.Modern Care Review 1990; 47(3):327–363.
Feldstein PJ, Wickizer TM, Wheeler JRC: The effects of utilization review programs on health care use and expenditures.New England Journal of Medicine 1988; 318(20):1310–1314.
Wickizer TM, Wheeler JRC, Feldstein PJ: Does utilization review reduce unnecessary hospital care and contain costs?Medical Care 1989; 27(6):632–647.
Allen H, Khandkher R: Aetna's Health Care Program (Fourth Quarter, 1987). Unpublished manuscript, Aetna Life & Casualty Company, Hartford, CT, 1987.
Tischler GL: Utilization management and the quality of care.Hospital and Community Psychiatry 1990; 41: 1099–1102.
Diagnostic and Statistical Manual III. Rev. ed. Washington, DC: American Psychiatric Press, 1987.
Namerow MJ: Outcome of Private Psychiatric Specialty Hospitalization. Unpublished report submitted to the National Association of Private Psychiatric Hospitals, Baltimore, MD, November 1990.
Appleby L, Desai PN, Luchins DJ, et al.: Length of stay and recidivism in schizophrenia: A study of public psychiatric hospital patients.American Journal of Psychiatry 1993; 150:72–76.
Frank RG, Salkever DS, Sharfstein SS: A new look at rising mental health insurance costs.Health Affairs 1991; 10:116–123.
Dickey B: A comparison of for-profit and not-for-profit hospitals on the cost of mental health admissions.Harvard Review of Psychiatry 1994; 2:97–103.
Kiesler CA, Simpkins C, Morton T: Predicting length of hospital stay for psychiatric inpatients.Hospital and Community Psychiatry 1990; 41:149–154.
Dickey B, Sederer LI, Eisen SV, et al.: Length of Stay and Clinical Outcome: A Comparison of Private Psychiatric Hospitals by Ownership Type. Submitted for publication, 1995.
Enthoven AC: Why managed care has failed to contain costs.Health Affairs 1993; 12:27–43.
Schreter RK: Ten trends in managed care and their impact on the biopsychosocial model.Hospital and Community Psychiatry 1993; 44:325–327.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Eisen, S.V., Griffin, M., Sederer, L.I. et al. The impact of preadmission approval and continued stay review on hospital stay and outcome among children and adolescents. The Journal of Mental Health Administration 22, 270–277 (1995). https://doi.org/10.1007/BF02521122
Issue Date:
DOI: https://doi.org/10.1007/BF02521122