Disability, outcome and case-mix in acute psychiatric in-patient units

Background Eighteen acute in-patient psychiatric units in Australia funded a syndicate to measure case-mix, disability and outcome of treatment, This syndicate included eight units in public general hospitals, five in stand-alone public psychiatric hospitals and five in private psychiatric hospitals. Method Up to 100 in-patients admitted consecutively to each hospital (1359 in all) were assigned to a Diagnosis-Related 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 information and length of stay were also recorded. Disability was measured by scores on the HoNOS and SF36 at admission, and outcome was assessed by the change in scores between admission and discharge. Results The public hospitals treated significantly more patients with schizophrenia and fewer with affective disorders, and their case load on admission was more disabled, on the whole, than that of the private hospitals. They achieved the same outcome or health gain as the private hospitals, but needed a shorter length of stay to do so, The addition of disability scores to DRG moderately increased the ability to predict length of stay. Conclusions Routine outcome assessment using reliable and valid instruments is practical, and could lead to improvements in the quality of care for psychiatric patients.