DISABILITY, OUTCOME AND CASE-MIX IN ACUTE PSYCHIATRIC INPATIENT UNITS

Background Eighteen acute in-patient psychiatric units in Australia fu nded a syndicate to measure case-mix, disability and outcome of treatm ent, This syndicate included eight units in public general hospitals, five in stand-alone public psychiatric hospitals and five in private p sychiatric hospitals. Method Up to 100 in-patients admitted consecutiv ely to each hospital (1359 in all) were assigned to a Diagnosis-Relate d Group (DRG), rated on the Health of the Nation Outcome Scales (HoNOS ) and asked to complete the Medical Outcomes Trust Short Form 36 (SF36 ). These scales were administered again at discharge. Demographic info rmation and length of stay were also recorded. Disability was measured by scores on the HoNOS and SF36 at admission, and outcome was assesse d by the change in scores between admission and discharge. Results The public hospitals treated significantly more patients with schizophren ia and fewer with affective disorders, and their case load on admissio n was more disabled, on the whole, than that of the private hospitals. They achieved the same outcome or health gain as the private hospital s, but needed a shorter length of stay to do so, The addition of disab ility scores to DRG moderately increased the ability to predict length of stay. Conclusions Routine outcome assessment using reliable and va lid instruments is practical, and could lead to improvements in the qu ality of care for psychiatric patients.