alexa Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007.


Bipolar Disorder: Open Access

Author(s): Blader JC

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Abstract CONTEXT: Data from facility-level surveys indicate that US inpatient psychiatric admissions rose in 2004, from their trough in 1998 to 2000, mainly in acute care settings. Patient-level factors, including age, admission type, diagnoses, length of stay, and payment source, are vital to understanding hospitalization trends. OBJECTIVE: To evaluate trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007 in relation to patient-level variables. Design, Setting, and PARTICIPANTS: The yearly National Hospital Discharge Survey furnished demographic, clinical, and payment data on a probability sample of discharges from short-stay facilities (mean [SD], 448.33 [19.66]), along with weights for extrapolation to population estimates. Discharges with a primary psychiatric diagnosis (mean [SD], 19 535 [2615]) were identified among children (aged 5-13 years), adolescents (aged 14-19 years), adults (aged 20-64 years), and elderly individuals (≥65 years). MAIN OUTCOME MEASURES: Annual rates of discharges and total days of inpatient care associated with primary psychiatric diagnoses for each age group. RESULTS: Psychiatric discharges increased for children from 155.54 per 100 000 children in 1996 to 283.04 per 100 000 in 2007 (P = .003); for adolescents, from 683.60 to 969.03 per 100 000 (P = . 001); and for adults, from 921.35 to 995.51 per 100 000 (P = .003) but declined for elderly individuals from 977.63 to 807.55 per 100 000 (P < .001). Total inpatient days increased for children (1845 days per 100 000 in 1996 to 4370 days in 2007; P = .02) and for adolescents (5882 days per 100 000 in 1996 to 8247 days in 2007; P < .001) but decreased for elderly patients (10 348 days per 100 000 in 1996 to 6517 days; P < .001). The proportion of inpatient days paid by private sources declined among children (36\%-21\%), adolescents (52\%-22\%), and adults (35\%-23\%; all P < .001). CONCLUSIONS: Inpatient discharges in short-stay facilities with a primary psychiatric diagnosis rose between 1996 and 2007, most dramatically for youth, but decreased among elderly individuals. Private funding bore a declining share of costs. This article was published in Arch Gen Psychiatry and referenced in Bipolar Disorder: Open Access

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