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Factors affecting prolonged length of stay in psychiatric patients in Japan: A retrospective observational study.

Factors affecting prolonged length of stay in psychiatric patients in Japan: A retrospective observational study.
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Shinjo D, Tachimori H, Sakurai K, Ohnuma T, Fujimori K, Fushimi K,


Shinjo D, Tachimori H, Sakurai K, Ohnuma T, Fujimori K, Fushimi K, (click to view)

Shinjo D, Tachimori H, Sakurai K, Ohnuma T, Fujimori K, Fushimi K,

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Psychiatry and clinical neurosciences 2017 03 14() doi 10.1111/pcn.12521
Abstract
AIM
Hospital length of stay is one of the stratified measures of health care efficiency and is commonly used to assess performance of psychiatric care. The aim of this study is to identify risk factors for prolonged length of stay of psychiatric patients.

METHODS
We retrospectively analyzed adult psychiatric patients (ICD-10; F-00-F99) between April of 2012 and March of 2014 in the Japanese Diagnosis Procedure Combination database. We examined factors affecting prolonged length of stay using multivariable logistic regression analysis. Subgroup analyses of the logistic regression were undertaken according to 2 diagnostic groups (F20-29 and F30-39).

RESULTS
A total of 34,326 patients admitted to and discharged from psychiatric beds were included. Older age, lower global assessment of functioning score, involuntary commitment, several psychiatric services, certain other patient factors, academic hospitals, public hospitals, and higher density of psychiatric beds were significantly associated with prolonged length of stay. Hospital patient volume was significantly associated with shorter length of stay. In the subgroup analyses, most of these factors were consistent although some were not associated with prolonged length of stay.

CONCLUSION
Not only clinical factors but also institutional characteristics were associated with prolonged length of stay. Our study provided useful information for improvement in psychiatric services and indicated the need to consider the division of roles between healthcare/welfare institutions and psychiatric-related resource allocation. Interventions should be considered for achieving shorter length of stay for psychiatric patients.

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