J H Bjørngaard1, T Heggestad. 1. SINTEF Unimed Helsetjenesteforskning 7465 Trondheim. johan.h.bjorngaard@unimed.sintef.no
Abstract
BACKGROUND: The proportion of patients admitted involuntarily varies considerably among Norwegian psychiatric hospitals. We tested the hypothesis that these variations are the result of differences in case-mix. MATERIAL AND METHODS: The observed differences in involuntary admissions to Norwegian psychiatric hospitals were compared to those expected on the basis of their case-mix, as predicted by our multivariate model (multinomial logistic regression). The material was based on a cross-sectional registration of hospitalized patients in Norwegian psychiatric hospitals as of 1 November 1999. Thirty-two hospitals (all Norwegian hospitals that take involuntary admissions) supplied data on a total of 1,500 patients. RESULTS: The analysis shows that a large amount of the observed variation in involuntary admissions is related to differences in case-mix. However, for patients involuntarily admitted for observation, the case-mix was found to have less explanatory effect. Age, sex, previous admissions and diagnoses were used to operationalize hospital case-mix. INTERPRETATION: The analysis also indicated that other explanatory factors should be explored, such as differences in admission threshold and in medical decision in explaining variation in involuntary psychiatric admissions.
BACKGROUND: The proportion of patients admitted involuntarily varies considerably among Norwegian psychiatric hospitals. We tested the hypothesis that these variations are the result of differences in case-mix. MATERIAL AND METHODS: The observed differences in involuntary admissions to Norwegian psychiatric hospitals were compared to those expected on the basis of their case-mix, as predicted by our multivariate model (multinomial logistic regression). The material was based on a cross-sectional registration of hospitalized patients in Norwegian psychiatric hospitals as of 1 November 1999. Thirty-two hospitals (all Norwegian hospitals that take involuntary admissions) supplied data on a total of 1,500 patients. RESULTS: The analysis shows that a large amount of the observed variation in involuntary admissions is related to differences in case-mix. However, for patients involuntarily admitted for observation, the case-mix was found to have less explanatory effect. Age, sex, previous admissions and diagnoses were used to operationalize hospital case-mix. INTERPRETATION: The analysis also indicated that other explanatory factors should be explored, such as differences in admission threshold and in medical decision in explaining variation in involuntary psychiatric admissions.