Showing papers by "Robert A. Rosenheck published in 1990"

The impact of DRG-based budgeting on inpatient psychiatric care in Veterans Administration medical centers.

Abstract: In 1985 the Veterans Administration (VA) implemented a prospective budgeting system for acute inpatient care based on diagnosis-related groups (DRGs). To assess the impact of this system on psychiatric care, this study reviewed data on all VA discharges for psychiatric or substance abuse disorders that occurred during the four years before and the four years after this system was implemented. During the four years following the implementation of DRG-based budgeting the number of annual discharges increased by 28.7% and the number of unique patients discharged increased by 15.5%. Average lengths of stay declined by 36.9% and total annual bed days of care per unique patient declined by 29.7%. These changes occurred in association with an 11.5% reduction in the total number of beds occupied by psychiatric patients, an 8.9% reduction in direct per diem expenditures for psychiatric care nationally, and a 32.7% decline in direct expenditures per episode, after adjustment is made for inflation. In spite of a continuing decline in the value of the available resources, largely due to the effect of inflation, prospective budgeting appears to have had a major impact on the pattern of inpatient psychiatric care in this large health care system.

Mentally ill chemical abusers discharged from VA inpatient treatment: 1976-1988.

Abstract: Discharge abstracts were analyzed for all patients discharged from Department of Veterans Affairs (VA) medical centers with a primary non-substance abuse psychiatric diagnosis over a twelve year period (1976 to 1988). Patients were identified as Mentally Ill Chemical Abusers (MICAs) if they had a primary mental illness diagnosis and either a secondary substance abuse diagnosis or an admission for substance abuse treatment during the same fiscal year. The percentage of MICAs doubled, from 22.6% to 43.6%, during these twelve years. In 1988, MICAs were younger and more likely to be minorities than other VA psychiatric patients, and they spent only half as many days in the hospital per year.

Regional variation in patterns of inpatient psychiatric care.

Abstract: Regional variation in both average length of stay and number of beds per 100,000 population is described for inpatient psychiatric care in the United States during 1983. The greatest differences were between the Northeast and Mid-Atlantic regions, on the one hand, and the Pacific and Southwest regions, on the other. Medical centers of the U.S. Department of Veterans Affairs (VA), whose policies are largely centrally determined, followed the same regional trends. Regional average length of stay, particularly in public sector mental health care organizations, was higher in regions with more occupied beds per 100,000 population.