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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
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Minerva Psichiatrica 2003 June;44(2):109-18


language: Italian

Organizational models and health costs of psychiatric care: the impact of diagnosis-related groups

Mungo S., Ferranini L., Boidi G., Copello F., Prelati M., Rosso V.


The increasing business ethos of local health authorities and hospitals and the extensive application of diagnosis-related groups (DRG), can produce substantial changes in organization and budget management in psychiatry.
The parameters which could differentiate psychiatry from other disciplines have been investigated by evaluating the role of the 9 main DRG in a psychiatric ward of a large, highly complex hospital. The six most common indicators of function, based on the application of DRG have been chosed: mean admission trend, coefficient of variation of hospitalization-length, comparative index of performance, mean number of diagnoses per hospital discharge form, case-mix, and re-admissions within 30 days, and have been compared with the hospital means. The ward under evaluation was the 2nd Psychiatric Department of the University which has an arrangement with the San Martino Hospital in Genova. The data refer to 1287 psychiatric admissions in five years (from 1995-1999). Although this Department historically does not have a territorially restricted catchment area and is elective for medium-long hospital-stay, the parameters considered were substantially consistent with those of the hospital's mean, with a progressive temporal improvement in performances, albeit inferior to the overall mean improvement of the hospital. The application logic of DRG does not take into account some important socio-environmental variables that significantly affect discharges and short-term readmissions. This seems to cause a progressive separation between the ever improving performances of the hospital as a whole and those of the psychiatry service in which these variables play a larger role. This, in turn, causes a distortion in the general organizational set-up, which could increasingly penalize hospital psychiatry with respect to other disciplines, and have a negative effect on community services and the society in general.

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