Predictors of cumulative length of psychiatric inpatient stay over one year: A national case register study

Abstract

Prior studies have shown inconsistent results regarding predictors of length of stay (LOS) and of readmission in psychiatric hospitals. "Cumulative LOS" over a given period, which reflects both LOS and readmission, has not been examined so far in a systematic way. The Israel Psychiatric Case Register in Israel made it possible to examine predictors of Cumulative LOS in a nationwide, representative sample. Method: All hospitalization admissions during a sixmonth period in Israel were recorded and followedup for one year. The variables predicting Cumulative LOS over one year were identified through a Cox regression. Results: The median Cumulative LOS during one year was 43.0 days, and only 1.7% of the patients remained hospitalized for more than one year after admission. The variables significantly predicting longer Cumulative LOS were: Jewish ethnicity, a diagnosis of schizophrenia or other functional psychosis, prior hospitalization, compulsory admission and Northern and Jerusalem districts of hospitalization (which have a lower admission rate). Limitations: Lack of information on severity of pathology and type of treatment. Conclusion: Cumulative LOS, which reflects both the length of each inpatient episode and the rate of readmission, is affected not only by clinical factors, but also by the cultural background of the patient population and by administrative factors such as bed pressure.