Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention
Received 17 July 2007; received in revised form 20 April 2009; accepted 23 April 2009. published online 05 October 2009. Corrected Proof
Abstract
Objective
Although there is a suggestion that the medical psychiatric unit (MPU) may reduce length of hospital stay (LOS), little is known about costs in terms of medical service use and psychiatric interventions in MPU care.
Method
A record linkage study was conducted, linking cost data of hospital medical service use, LOS, and hospital psychiatric interventions to patients admitted to the MPU of the Maastricht University Medical Centre (MUMC) between 1998 and 2004. The data set was analyzed to enable comparison between cost changes of the same complex patient population following either MPU index admission or index admissions to reference MUMC medical wards.
Results
Comparisons revealed lower costs of medical service use in favor of the MPU (−€104; 95% CI −€174 to −€35; P<.01). However, cost of psychiatric intervention and cost of LOS were higher after MPU admission (respectively, +€165; 95% CI +€25 to +€305; P<.05; and +€202; 95% CI +€170 to +€235; P<.001). Total costs were higher after MPU admission compared to medical ward admission (+€263; 95% CI +€68 to +€458; P<.05). These differences were not moderated by somatic diagnosis or previous pattern of admissions.
Conclusion
The findings suggest that patients at the interface of psychiatric and somatic morbidity are diagnosed and treated adequately at the MPU, leading to a decrease in medical service use and an appropriate increase in exposure to psychiatric interventions. These results are specifically generalizable to MPUs with a focus on psychosomatic conditions, for instance, somatoform disorders or affective disorders with comorbid somatic diseases. However, failure to show cost savings in terms of LOS compared to medical wards outweighs cost–benefit derived from lower medical service use, suggesting that MPU activities may gain in cost-effectiveness if shifted more to outpatient psychosomatic care solutions.
aDepartment of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
bDepartment of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
cDepartment of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
dDivision of Psychological Medicine, Institute of Psychiatry, London, United Kingdom
Corresponding author. Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, PO BOX 5800 (DRT, NIV 4), 6202 AZ Maastricht, The Netherlands. Tel.: +31 43 3877444; fax: +31 43 3875444.
ABSTRACT