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Psychiatric severity of illness. A case mix study
S D Horn1, A F Chambers, P D Sharkey
1Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205.
Medical Care
|January 1, 1989
Summary
The Psychiatric Severity of Illness Index creates more homogeneous psychiatric patient groups for resource use compared to diagnosis-related groups (DRGs). This improved grouping better explains variations in patient length of stay.
Area of Science:
- Health Services Research
- Psychiatric Epidemiology
- Medical Economics
Background:
- Diagnosis-related groups (DRGs) are widely used for hospital reimbursement and case-mix classification.
- However, DRGs may not adequately capture the complexity and resource utilization of psychiatric patients.
- A more refined measure of illness severity is needed for accurate psychiatric case-mix grouping.
Purpose of the Study:
- To evaluate the Psychiatric Severity of Illness Index's ability to create homogeneous psychiatric case-mix groups.
- To compare the homogeneity of psychiatric case-mix groups generated by the Psychiatric Severity of Illness Index versus DRGs.
- To assess the impact of these groupings on explaining variation in resource use, specifically length of stay.
Main Methods:
- Collected Psychiatric Severity of Illness data on 1,672 psychiatric patients across ten hospitals.
- Scored 1,418 cases using the Psychiatric Severity Index, focusing on 1,173 cases within MDC 19 (mental diseases and disorders).
- Analyzed the variation in length of stay explained by the Psychiatric Severity of Illness groups and DRGs, both independently and combined.
Main Results:
- Four Psychiatric Severity of Illness groups explained 34%-50% of the variation in length of stay for MDC 19 patients.
- Nine DRGs explained only 6%-14% of the variation in length of stay for the same patient group.
- DRGs subdivided by Psychiatric Severity of Illness groups explained a higher variation (40%-54%) in length of stay.
Conclusions:
- The Psychiatric Severity of Illness Index provides a more effective method for grouping psychiatric patients based on resource use than traditional DRGs.
- Combining DRGs with the Psychiatric Severity of Illness Index further enhances the explanation of length-of-stay variation.
- These findings have significant implications for improving cross-hospital comparisons and resource allocation in psychiatric care.