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Assessment of Psychiatric Outcomes in Japan Based on Diagnostic Procedure Combination Information

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Abstract

We evaluated psychiatric care in terms of relationships between patient characteristics and a comprehensive measurement of psychiatric outcomes among inpatients with lengths of stay (LOSs) of 90 days or fewer in a psychiatric hospital in Japan. The sample consisted of inpatients discharged from an acute care psychiatric hospital between September 1 and December 31, 2007. Multivariate analyses were performed to identify patient characteristics related to the outcome of acute psychiatric care. The type of admission was related to difference in Global Assessment of Functioning (GAF) scores (P < 0.001), health care cost (P < 0.001), length of time spent in seclusion (P < 0.001), and length of time spent in restraints (P < 0.01). Diagnosis showed a minimal or non-existent relationship to the outcome variables. The GAF scores of involuntary patients with initially low scores on this axis were greatly improved at discharge. Patients who were admitted involuntarily received more coercive interventions and treatments, such as seclusion and restraints, than did patients with who were admitted voluntarily. Diagnostic groups did not differ in terms of GAF scores. Further studies utilizing diagnostic procedure combination (DPC) data from multiple medical institutions are necessary to verify the present findings.

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References

  1. Ministry of Health, Labour and Welfare: Kokumin iryouhi no gaikyo, 2007 [Summary of National Health Care Costs]. http://www.mhlw.go.jp/toukei/saikin/hw/k-iryohi/07/. Accessed May 1, 2010 [in Japanese].

  2. Ministry of Health, Labour and Welfare: Kanja tyosa no gaikyo, 2008 [Summary of Patient Survey]. http://www.mhlw.go.jp/toukei/saikin/hw/kanja/08/index.html. Accessed May 1, 2010 [in Japanese].

  3. Ministry of Health, Labour and Welfare: Central Social Insurance Medical Council, Medical Fee Committee, 2008. http://www.mhlw.go.jp/shingi/2008/07/s0716-4.html. Accessed May 1, 2010 [in Japanese].

  4. Ministry of Health, Labour and Welfare: Medical Fee and DPC Committee, 2008. http://www.mhlw.go.jp/shingi/2008/11/txt/s1112-5.txt. Accessed May 1, 2010 [in Japanese].

  5. Matsuda S: DPC no seishinka heno donyu [Introduction of DPC to the psychiatric department]. Seisin Shinkeigaku Zasshi 111(5):560–566, 2009 [In Japanese].

  6. Hirakawa J: Kyuseiki seisinnka iryo no arikata to DPC seido [Acute stage psychiatric care and the DPC system]. Seisin Shinkeigaku Zasshi 111(5):585–587, 2009.

    Google Scholar 

  7. Oliva-Moreno J, López-Bastida J, Montejo-González, Osuna-Guerrero R, Duque-González B: The socioeconomic costs of mental illness in Spain. European Journal of Health Economics 10:361–369, 2009.

    Article  PubMed  Google Scholar 

  8. Fitzgerald PB, Montgomery W, de Castella AR, Filla KM, Filla SL, Christova L, Jackson D, Kulkarni J: Australian schizophrenia care and assessment programme: Real-world schizophrenia: Economics. Australian New Zealand Journal of Psychiatry 41(10):819–829, 2007.

    Article  Google Scholar 

  9. Schreyögg J, Tiemann O, Busse R: Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system? Health Care Management Science 9:269–279, 2006.

    Article  PubMed  Google Scholar 

  10. Ben-Tovim DI, Elzinga RH: Making case-mix work for psychiatry. Medical Journal Australia 161(Suppl):S33–S36, 1994.

    Google Scholar 

  11. Hochlehnert A, Niehoff D, Herzog W, Löwe B: Elevated costs of treatment in medical inpatients with psychiatric co-morbidity are not reflected in the German DRG-system. Psychotherapie Psychosomatik Medicinische Psychologie 57(2):70–75, 2007.

    Article  Google Scholar 

  12. Pilgrim D: The survival of psychiatric diagnosis. Social Science and Medicine 65:536–547, 2007.

    Article  PubMed  Google Scholar 

  13. Bourgeois JA, Kremen WS, Servis ME, Wegelin JA, Hales RE: The impact of psychiatric diagnosis on length of stay in a university medical center in the Managed Care era. Psychosomatics 46(5):431–439, 2005.

    Article  PubMed  Google Scholar 

  14. Andreas S, Dirmaier J, Harfst T, Kawski S, Koch U, Schulz H: Development and evaluation of a case group concept for inpatients with mental disorders in Germany: Using self-report and expert-rated instruments. European Psychiatry 24:105–111, 2009.

    Article  PubMed  Google Scholar 

  15. Warnke I, Rössler W: Length of stay by ICD-based diagnostic groups as basis for the remuneration of psychiatric inpatient care in Switzerland? Swiss Medical Weekly 138(35–36):520–527, 2008.

    PubMed  Google Scholar 

  16. Taube C, Lee ES, Forthofer RN: DRGs in psychiatry: An empirical evaluation. Medical Care 22(7):597–610, 1984.

    Article  PubMed  CAS  Google Scholar 

  17. Schumacher DN, Namerow MJ, Parker B, Fox P, Kofie V: Prospective payment for psychiatry: Feasibility and impact. New England Journal of Medicine 315(21):1331–1336, 1986.

    Article  PubMed  CAS  Google Scholar 

  18. Phelan M, McCrone P: Effectiveness of diagnosis-related groups in predicting psychiatric resource utilization in the UK. Psychiatric Services 46(6):547–549, 1995.

    PubMed  CAS  Google Scholar 

  19. Kjellin L: Compulsory psychiatric care in Sweden 1979-1993. Social Psychiatry and Psychiatric Epidemiology 32:90–96, 1997.

    Article  PubMed  CAS  Google Scholar 

  20. Wallsten T, Kjellin L: Involuntarily and voluntarily admitted patients’ experiences of psychiatric admission and treatment: A comparison before and after changed legislation in Sweden. European Psychiatry 19:464–468, 2004.

    Article  PubMed  Google Scholar 

  21. Katsakou C, Priebe S: Outcomes of involuntary hospital admission: A review. Acta Psychiartica Scandinavica 114:232–241, 2006.

    Article  CAS  Google Scholar 

  22. Kjellin L, Høyer G, Engberg M, Kaltiala-Heino R, Sigurjónsdóttir M: Differences in perceived coercion at admission to psychiatric hospitals in the Nordic countries. Social Psychiatry & Psychiatric Epidemiology 41:241–247, 2006.

    Article  PubMed  Google Scholar 

  23. Fu JCK, C PPL, Lam LCW: The experience of admission to psychiatric hospitals among Chinese adult patients in Hong Kong. BMC Psychiatry 8:85–96, 2008.

    Article  Google Scholar 

  24. Shirakawa O, Hitomi Y, Kirimi E, Azuma M: DPC: seidoka no tokutei kinou byoin ippan byosho deno seishinka iryo [Psychiatric care in the general ward of a hospital with a specific function and operated under the DPC system]. Seisin Shinkeigaku Zasshi 111(5):567–571, 2009 [In Japanese].

    Google Scholar 

  25. Matsuda S: DPC no seishinka heno donyu [Introduction of DPC to the psychiatric department]. Seisin Shinkeigaku Zasshi (Supp):S-271, 2008 [In Japanese].

  26. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Text Revision, 4th edn. Washington, DC, p. 34, 1994.

  27. World Health Organization: International Classification of Diseases (ICD)-10. http://apps.who.int/classifications/apps/icd/icd10online/. Accessed May 1, 2010.

  28. Ministry of Health, Labour and Welfare: http://www.mhlw.go.jp/shingi/2009/05/dl/s0514-6b_0033.pdf. Accessed May 1, 2010.

  29. Chung W, Cho WH, Yoon CW: The influence of institutional characteristics on length of stay for psychiatric patients: A national database study in South Korea. Social Science & Medicine 68:1137–1144, 2009.

    Article  PubMed  Google Scholar 

  30. Imai H, Hosomi J, Nakao H, Tsumino H, Katoh T, Itoh T, Yoshida T: Characteristics of psychiatric hospitals associated with length of stay in Japan. Health Policy 74:115–121, 2005.

    Article  PubMed  Google Scholar 

  31. Söderberg P, Tungström S, Armelius BA: Reliability of Global Assessment of Functioning ratings made by clinical psychiatric staff. Psychiatric Services 56(4):434–438, 2005.

    Article  PubMed  Google Scholar 

  32. Lin HC, Tian WH, Chen CS, Liu TC, Tsai SY, Lee HC: The association between readmission rates and length of stay for schizophrenia: A 3-year population-based study. Schizophrenia Research 83:211–214, 2006.

    Article  PubMed  Google Scholar 

  33. Rosca P, Bauer A, Grinshpoon A, Khawaled R, Mester R, Ponizovsky AM: Rehospitalization among psychiatric patients whose first admission was involuntary: A 10-year follow-up. Israel Journal of Psychiatry and Related Sciences 43(1):57–64, 2006.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Health Services, Management and Policy, Kyushu University Graduate School of Medicine, Fukuoka, Japan

    Takeru Abe

  2. Department of Health Care Administration and Management, Kyushu University Graduate School of Medicine, 3-1-1 Higashi-ku, Fukuoka, 812-8582, Japan

    Koji Ikeda & Akihito Hagihara

  3. Hannan Hospital, Osaka, Japan

    Kenji Kuroda

Authors
  1. Takeru Abe
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  2. Koji Ikeda
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  3. Kenji Kuroda
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  4. Akihito Hagihara
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Correspondence to Akihito Hagihara.

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Abe, T., Ikeda, K., Kuroda, K. et al. Assessment of Psychiatric Outcomes in Japan Based on Diagnostic Procedure Combination Information. Psychiatr Q 82, 163–175 (2011). https://doi.org/10.1007/s11126-010-9158-7

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  • DOI: https://doi.org/10.1007/s11126-010-9158-7

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