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[Can case-mix explain differences in involuntary admissions?].

J H Bjørngaard1, T Heggestad

  • 1SINTEF Unimed Helsetjenesteforskning 7465 Trondheim. johan.h.bjorngaard@unimed.sintef.no

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|February 6, 2002
PubMed
Summary

Variations in involuntary psychiatric admissions across Norwegian hospitals are largely explained by patient case-mix differences. However, case-mix had less impact on involuntary observation admissions, suggesting other factors are at play.

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Area of Science:

  • Psychiatric epidemiology
  • Health services research
  • Clinical psychology

Background:

  • Significant variations exist in the proportion of involuntarily admitted patients among Norwegian psychiatric hospitals.
  • Previous research has not fully elucidated the reasons behind these inter-hospital disparities in involuntary admissions.

Purpose of the Study:

  • To test the hypothesis that variations in involuntary psychiatric admissions are primarily driven by differences in patient case-mix.
  • To quantify the extent to which case-mix explains observed variations in involuntary admission rates across Norwegian psychiatric hospitals.

Main Methods:

  • A cross-sectional study utilizing data from 32 Norwegian psychiatric hospitals, including 1,500 hospitalized patients as of November 1, 1999.
  • Multivariate analysis, specifically multinomial logistic regression, was employed to compare observed involuntary admissions with those predicted by patient case-mix.

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  • Patient case-mix was operationalized using variables such as age, sex, previous admission history, and diagnoses.

    • Main Results:

    • Differences in patient case-mix significantly explained a substantial portion of the observed variation in involuntary psychiatric admissions.
    • The explanatory power of case-mix was notably lower for patients admitted involuntarily for observation purposes.
    • Key case-mix factors identified included patient age, sex, prior admission history, and specific diagnoses.

    Conclusions:

    • Patient case-mix is a significant, but not the sole, determinant of variations in involuntary psychiatric admissions.
    • Further research is warranted to explore other contributing factors, including variations in admission thresholds and clinical decision-making processes.
    • Understanding these factors is crucial for developing targeted interventions to reduce unwarranted variations in involuntary psychiatric care.