Am J Psychiatry 1991; 148:892-897
Copyright © 1991 by American Psychiatric Association
Have general hospitals become chronic care institutions for the mentally ill?
SA Salit and LR Marcos
New York City Health and Hospitals Corporation, NY 10036.
OBJECTIVE: Dramatic increases in lengths of stay for general hospital
psychiatric patients in New York City in recent years have raised
speculation that general hospitals are assuming a large responsibility for
care of the chronically mentally ill. This study examines changes in
utilization patterns and patient characteristics to assess whether such a
trend is occurring. METHOD: The authors obtained discharge abstract data
for all New York City general hospital adult psychiatric patients in 1985
and 1988 as well as utilization data from the public general hospital
system for 1977-1989. Three measures of chronicity were chosen: hospital
stays longer than 60 days, discharges to long- term care, and three or more
admissions per year. Data on psychiatric diagnoses and comorbid diagnoses
for chronically ill patients were also reviewed. RESULTS: The mean length
of stay of psychiatric patients in general hospitals has increased
substantially in recent years and nearly tripled in the public hospitals
during 1977-1989. Between 1985 and 1988, citywide increases were due
largely to a growing proportion of patients with very long stays. Patients
with stays longer than 60 days accounted for 35% of all inpatient days in
1988, compared with 27% in 1985. Patients with chronic illness accounted
for half of all days in 1988, compared with 38% in 1985. CONCLUSIONS:
Although many factors have contributed to these trends, the leading cause
has been reimbursement policies favoring short-term inpatient care.
Improving accountability for community treatment programs will be the key
to redirecting funding priorities and creating more appropriate
alternatives for the chronically mentally ill.
