Association of high psychiatrist staffing with prolonged hospitalization, follow-up visits, and readmission in acute psychiatric units: a retrospective cohort study using a nationwide claims database
Received 26 December 2017
Accepted for publication 15 February 2018
Published 28 March 2018 Volume 2018:14 Pages 893—902
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Taro Kishi
Yasuyuki Okumura,1 Naoya Sugiyama,2 Toshie Noda,3 Nobuo Sakata1
1Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; 2Numazu Chuo Hospital, Fukkokai Foundation, Shizuoka, Japan; 3Atami Chuo Clinic, Fukkokai Foundation, Shizuoka, Japan
Background: The effects of psychiatrist staffing are unclear. The aim of this study was to assess the association of high psychiatrist staffing with prolonged hospitalization, follow-up visits, and readmission in acute psychiatric units.
Methods: A retrospective cohort study was conducted using the National Database of Health Insurance Claim Information and Specified Medical Checkups. Patients newly admitted to acute psychiatric units between October 2014 and September 2015 were followed up until September 2016. The primary exposure was a patient-to-psychiatrist ratio of 16:1 (high-staffing units) vs 48:1 (low-staffing units). Outcomes were prolonged hospitalization of >90 days, number of follow-up psychiatric visits within 90 days after discharge, and psychiatric readmission within 90 days after discharge. Incidence rate ratios (IRRs) and their 95% confidence intervals (CIs) were estimated by using generalized estimating equations, adjusting for potential covariates.
Results: Among the 24,678 newly admitted patients at 190 hospitals, 13,138 patients (53.2%) were admitted to high-staffing units in 92 hospitals. After adjustment, high-staffing units were associated with a lower risk of prolonged hospitalization (incidence rate, 16.9 vs 21.3%; IRR, 0.79 [95% CI, 0.70, 0.89]), higher number of follow-up visits (incidence rate of ≥7 visits, 16.9 vs 13.4%; IRR, 1.06 [95% CI, 1.01, 1.12]), and lower risk of readmission (incidence rate, 13.0 vs 14.4%; IRR, 0.90 [95% CI, 0.82, 0.99]).
Conclusion: High-staffing units are associated with a reduced risk of prolonged hospitalization and readmission and an increased number of follow-up visits. Further research is needed to improve the generalizability of these findings and establish the optimal level of staffing.
Keywords: readmission rate, length of stay, quality of care, physician ratio, workforce, psychiatrist staffing
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