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Case mix in the "downsizing" state hospital

W H Fisher1, L Simon, J L Geller

  • 1University of Massachusetts Medical School, Worcester 01655, USA.

Psychiatric Services (Washington, D.C.)
|March 1, 1996
PubMed
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State hospital census reduction impacted patient case mix differently based on community service availability. Hospitals in areas with more services saw shifts towards higher-risk patients with lower functioning levels.

Area of Science:

  • Health Services Research
  • Psychiatric Epidemiology
  • Hospital Administration

Background:

  • State hospitals are undergoing significant census reduction.
  • Community-based services are expanding as alternatives to state hospital care.
  • Variations in community resource availability may influence the types of patients remaining in state hospitals.

Purpose of the Study:

  • To investigate the impact of local community-based service levels on the case mix of state hospitals during census reduction.
  • To compare patient characteristics at hospitals with differing rates of census reduction.
  • To analyze sociodemographic, diagnostic, and functional trends over a 14-year period.

Main Methods:

  • Longitudinal analysis of case mix trends over 14 years at two Massachusetts state hospitals.

Related Experiment Videos

  • Comparison of patient data from 1977, 1986, and 1991, representing key points in census reduction.
  • Assessment of patient hospital use, sociodemographic, diagnostic, behavioral, and functional characteristics.

    • Main Results:

    • Both hospitals showed parallel trends during census reduction.
    • The hospital in an area with greater community services had fewer elderly and long-stay patients by 1986.
    • By 1991, this hospital also had more admissions per patient, higher-risk violent behaviors, and lower patient functioning.

    Conclusions:

    • Expanded community services and alternative beds did not divert all patient subgroups, such as recidivists and high-risk individuals.
    • State hospitals may retain more complex and challenging patient populations.
    • Future deinstitutionalization and privatization efforts must account for the needs of these remaining patient subgroups.