Impact of shortened hospitalization on outcome parameters.

Due to administratively mandated changes in the reimbursement system for inpatient treatment, average length of hospital stay in a geropsychiatric hospital unit decreased by approximately 20% within 1 year. The impact of this change on selected key parameters of effective therapeutic management are analyzed. Three 90-day periods were compared, one before, two after the reduction in length of stay. It was found that postdischarge referrals to facilities with a higher level of restrictiveness than prior to hospitalization increased significantly from Period 1 to Period 2, but returned to the original level in Period 3. These findings were confirmed when data were corrected for changes in the diagnostic composition of the respective samples. Patients who lacked natural support systems were more likely to be referred to a postdischarge setting of greater restrictiveness than before the admission. This finding remained constant. Readmission figures increased by 5% immediately after introduction of the decreased average length of stay (Period 2). When corrected for diagnostic composition, early recidivism also returned to original level in Period 3. Patients' insurance status appeared unrelated to any of the measured variables. Some observations on the composition of the diagnostic mosaic among admissions over time and the relations between diagnostic categories and average length of stay are included.