[Days in psychiatric hospitals: who consumes most of them? A five-year record linkage study of "Heavy Users" in an Austrian province]

Abstract

Objective: To find out whether the use of hospital days in all psychiatric inpatient services in the province of Lower Austria is equally distributed among patients or whether subgroups with different intensity of hospital day use can be identified, and if so, how these subgroups can be characterized.

Methods: Data collected for administrative purposes for all three inpatient services of Lower Austria were analyzed for the years 1996 to 2000. Record Linkage allowed to identify patients who had used several of these hospitals within the respective study periods. Cumulative hospital days per patient were calculated for each of the years studied and the distribution of these cumulative hospital days was analyzed.

Results: Of the 202 996 hospital days accrued in the year 1996, 44.5 % were consumed by patients who continuously stayed in hospital during the whole year ("static" population). In 2000 this percentage had dropped to 16.3 %; also the total number of hospital days had decreased by one third to 141 738. Of those patients, who had at least once been admitted and/or discharged during a specific year ("dynamic population"), a stable proportion of around 17.0 % were responsible for 50.0 % of all hospital days. These patients were more frequently of female sex, significantly younger, had more often repeated admissions and suffered more frequently from schizophrenia than the rest of the group.

Conclusions: The astonishing finding that, despite substantial change in the system of psychiatric care over five years, the percentage of patients with high values for cumulative hospital days remains constant, warrants further analyses. In such analyses not only patient and illness characteristics should be studied (which is suggested by the terms "heavy users" and "high utilizers"), but also factors such as the social context of the patient, the existence or non-existence of community psychiatric services and their functioning, as well as existing or non-existing financial incentives for single services.