Assessment of Psychiatric Outcomes in Japan Based on Diagnostic Procedure Combination Information
We evaluated psychiatric care in terms of relationships between patient characteristics and a comprehensive measurement of psychiatric outcomes among inpatients with lengths of stay (LOSs) of 90 days or fewer in a psychiatric hospital in Japan. The sample consisted of inpatients discharged from an acute care psychiatric hospital between September 1 and December 31, 2007. Multivariate analyses were performed to identify patient characteristics related to the outcome of acute psychiatric care. The type of admission was related to difference in Global Assessment of Functioning (GAF) scores (P < 0.001), health care cost (P < 0.001), length of time spent in seclusion (P < 0.001), and length of time spent in restraints (P < 0.01). Diagnosis showed a minimal or non-existent relationship to the outcome variables. The GAF scores of involuntary patients with initially low scores on this axis were greatly improved at discharge. Patients who were admitted involuntarily received more coercive interventions and treatments, such as seclusion and restraints, than did patients with who were admitted voluntarily. Diagnostic groups did not differ in terms of GAF scores. Further studies utilizing diagnostic procedure combination (DPC) data from multiple medical institutions are necessary to verify the present findings.
KeywordsAcute psychiatric care Outcome Diagnostic procedure combination
- 1.Ministry of Health, Labour and Welfare: Kokumin iryouhi no gaikyo, 2007 [Summary of National Health Care Costs]. http://www.mhlw.go.jp/toukei/saikin/hw/k-iryohi/07/. Accessed May 1, 2010 [in Japanese].
- 2.Ministry of Health, Labour and Welfare: Kanja tyosa no gaikyo, 2008 [Summary of Patient Survey]. http://www.mhlw.go.jp/toukei/saikin/hw/kanja/08/index.html. Accessed May 1, 2010 [in Japanese].
- 3.Ministry of Health, Labour and Welfare: Central Social Insurance Medical Council, Medical Fee Committee, 2008. http://www.mhlw.go.jp/shingi/2008/07/s0716-4.html. Accessed May 1, 2010 [in Japanese].
- 4.Ministry of Health, Labour and Welfare: Medical Fee and DPC Committee, 2008. http://www.mhlw.go.jp/shingi/2008/11/txt/s1112-5.txt. Accessed May 1, 2010 [in Japanese].
- 5.Matsuda S: DPC no seishinka heno donyu [Introduction of DPC to the psychiatric department]. Seisin Shinkeigaku Zasshi 111(5):560–566, 2009 [In Japanese].Google Scholar
- 6.Hirakawa J: Kyuseiki seisinnka iryo no arikata to DPC seido [Acute stage psychiatric care and the DPC system]. Seisin Shinkeigaku Zasshi 111(5):585–587, 2009.Google Scholar
- 10.Ben-Tovim DI, Elzinga RH: Making case-mix work for psychiatry. Medical Journal Australia 161(Suppl):S33–S36, 1994.Google Scholar
- 24.Shirakawa O, Hitomi Y, Kirimi E, Azuma M: DPC: seidoka no tokutei kinou byoin ippan byosho deno seishinka iryo [Psychiatric care in the general ward of a hospital with a specific function and operated under the DPC system]. Seisin Shinkeigaku Zasshi 111(5):567–571, 2009 [In Japanese].Google Scholar
- 25.Matsuda S: DPC no seishinka heno donyu [Introduction of DPC to the psychiatric department]. Seisin Shinkeigaku Zasshi (Supp):S-271, 2008 [In Japanese].Google Scholar
- 26.American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Text Revision, 4th edn. Washington, DC, p. 34, 1994.Google Scholar
- 27.World Health Organization: International Classification of Diseases (ICD)-10. http://apps.who.int/classifications/apps/icd/icd10online/. Accessed May 1, 2010.
- 28.Ministry of Health, Labour and Welfare: http://www.mhlw.go.jp/shingi/2009/05/dl/s0514-6b_0033.pdf. Accessed May 1, 2010.