Background. Diagnostic Related Groups (DRGs) and Healthcare
Resource Groups (HRGs) do
not predict accurately length of stay or resources needed for
treatment in psychiatry. This preliminary study assessed the relative
contribution of severity of illness, in combination with other
variables, in predicting length of stay.
Method. Data were analysed on 115 consecutive admissions to
a
district psychiatric in-patient
unit to assess the variables which most accurately predict length of stay.
The variables included demographic data, diagnosis, clinical, social and
behavioural measures.
Results. For initial admission, diagnosis of neurosis predicted
shortest stay, but diagnosis alone
accounted for only 14·6% of the variation in length of stay.
Addition of Social Behaviour Scale
score, living alone and specific psychiatric symptoms significantly
increased the predictive value (adjusted R2=36·6%).
Addition of variables available at discharge (use of ECT, major
tranquillizers and antidepressants) significantly increased the adjusted
R2 to 49·0%. Prediction
of total length of hospitalization over a 12-month period, from the
date of initial admission, indicated that mania predicted the longest
stay and addition of other variables meant that only
18·9% of length of stay was predicted.
Conclusion. If these results are borne out in a larger study,
they indicate that diagnostic or
health related groups (DRGs) are only likely to be useful in psychiatry
if
they include more detailed social, clinical and behavioural variables.