Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions

Nazlee Siddiqui, Mitchell Dwyer, Jim Stankovich, Gregory Peterson, David Greenfield, Lei Si, Leigh Kinsman

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: With the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions.

Methods: The retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days’ use between patients with and without comorbidity of mental illness.

Results: Patients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days’ use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%–159%) and 109% (78%–146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%–59.9%).

Conclusions: Mental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.
LanguageEnglish
Article number498
Pages1-10
Number of pages10
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
Publication statusPublished - 27 Jun 2018

Fingerprint

Comorbidity
Length of Stay
Retrospective Studies
Morbidity
Tasmania
Stroke
Patient Care Team
Cost of Illness
Confounding Factors (Epidemiology)
Patient Admission
Public Hospitals
Mentally Ill Persons
Statistical Models
Mental Disorders
Chronic Obstructive Pulmonary Disease
Type 2 Diabetes Mellitus
Myocardial Ischemia
Colorectal Neoplasms
Lung Neoplasms
Neoplasms

Bibliographical note

Copyright The Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Comorbidities
  • LOS variation
  • hospital

Cite this

Siddiqui, Nazlee ; Dwyer, Mitchell ; Stankovich, Jim ; Peterson, Gregory ; Greenfield, David ; Si, Lei ; Kinsman, Leigh. / Hospital length of stay variation and comorbidity of mental illness : a retrospective study of five common chronic medical conditions. In: BMC Health Services Research. 2018 ; Vol. 18, No. 1. pp. 1-10.
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Hospital length of stay variation and comorbidity of mental illness : a retrospective study of five common chronic medical conditions. / Siddiqui, Nazlee; Dwyer, Mitchell; Stankovich, Jim; Peterson, Gregory; Greenfield, David; Si, Lei; Kinsman, Leigh.

In: BMC Health Services Research, Vol. 18, No. 1, 498, 27.06.2018, p. 1-10.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Dwyer, Mitchell

AU - Stankovich, Jim

AU - Peterson, Gregory

AU - Greenfield, David

AU - Si, Lei

AU - Kinsman, Leigh

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N2 - Background: With the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions.Methods: The retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days’ use between patients with and without comorbidity of mental illness.Results: Patients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days’ use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%–159%) and 109% (78%–146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%–59.9%).Conclusions: Mental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.

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