A sequence analysis of hospitalization patterns and service utilization in patients with major psychiatric disorders in China

• Type of Material: Article
• Authors: Xueyan Han, Peking University First Hospital; Feng Jiang, Shanghai Jiao Tong University; Jack Needleman, University of California Los Angeles; Moning Guo, Beijing Municipal Health Commission Information Centre; Yin Chen, Peking University; Huixuan Zhou, Beijing Sport University; Yuanli Liu, Chinese Academy of Medical Sciences and Peking Union Medical College; Chen Yao, Peking University First Hospital; Yilang Tang, Emory University
• Language: English
• Date: 2021-05-11
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12888-021-03251-w
• Title of Journal or Parent Work: BMC PSYCHIATRY
• Volume: 21
• Issue: 1
• Start Page: 245
• End Page: 245
• Grant/Funding Information: This research was funded by China Medical Board (CMB-OC (2018) 17–278).
• Keywords: MENTAL-HEALTH; Psychiatric service; Science & Technology; China; Sequence analysis; DISCHARGE; Psychiatric readmission; PREVALENCE; Life Sciences & Biomedicine; Psychiatry; INPATIENT SERVICE; Hospitalization pattern; CARE; QUALITY; READMISSIONS
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Background: Understanding the long-term inpatient service cost and utilization of psychiatric patients may provide insight into service demand for these patients and guide the design of targeted mental health programs. This study assesses 3-year hospitalization patterns and quantifies service utilization intensity of psychiatric patients in Beijing, China. Methods: We identified patients admitted for one of three major psychiatric disorders (schizophrenia, bipolar and depressive disorders) between January 1 and December 31, 2013 in Beijing, China. Inpatient admissions during the following 3 years were extracted and analyzed using sequence analysis. Clinical characteristics, psychiatric and non-psychiatric service use of included patients were analyzed. Results: The study included 3443 patients (7657 hospitalizations). The patient hospitalization sequences were grouped into 4 clusters: short stay (N = 2741 (79.61% of patients), who had 126,911 or 26.82% of the hospital days within the sample), repeated long stay (N = 404 (11.73%), 76,915 (16.26%) days), long-term stay (N = 101 (2.93%), 59,909 (12.66%) days) and permanent stay (N = 197 (5.72%), 209,402 (44.26%) days). Length and frequency of hospitalization, as well as readmission rates were significantly different across the 4 clusters. Over the 3-year period, hospitalization days per year decreased for patients in the short stay and repeated long stay clusters. Patients with schizophrenia (1705 (49.52%)) had 78.4% of cumulative psychiatric stays, with 11.14% of them in the permanent stay cluster. Among patients with depression, 23.11% had non-psychiatric hospitalizations, and on average 46.65% of their total inpatient expenses were for non-psychiatric care, the highest among three diagnostic groups. Conclusion: Hospitalization patterns varied significantly among psychiatric patients and across diagnostic categories. The high psychiatric care service use of the long-term and permanent stay patients underlines the need for evidence-based interventions to reduce cost and improve care quality.