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Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions

Siddiqui, N ORCID: 0000-0002-1841-3095, Dwyer, MA ORCID: 0000-0002-9956-2569, Stankovich, J ORCID: 0000-0001-9344-7749, Peterson, G ORCID: 0000-0002-6764-3882, Greenfield, D ORCID: 0000-0002-0927-6025, Si, L and Kinsman, L ORCID: 0000-0002-0790-5887 2018 , 'Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions' , BMC Health Services Research , pp. 1-10 , doi:

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Background: With the increasing burden of mental illness globally, it is becoming common for hospitalisedpatients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolonglength of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals tocharacterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOSvariation across different chronic medical conditions.Methods: The retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of fivechronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type IIdiabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitalsthat collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used tocompare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. Weused negative binomial regression models to assess whether co-morbidity of mental illness, along with its subtypes,after adjustment for potential confounding variables, associated with LOS variation in patients of eachmedical condition. Based on the adjusted LOS variation, we estimated differences in bed days’ use betweenpatients with and without comorbidity of mental illness.Results: Patients with co-morbidity of mental illness were significantly younger in comparison to patients withoutmental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher beddays’ use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illnessunfavourably affected the LOS variation by as high as 97% (CI: 49.9%–159%) and 109% (78%–146%), respectively.Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mentalillness across the medical conditions, it contributed significant unfavourable LOS variation only in the strokepatients i.e. 36.3% (CI: 16.2%–59.9%).Conclusions: Mental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams andgreater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessaryto provide improved medical care and achieve system efficiencies.

Item Type: Article
Authors/Creators:Siddiqui, N and Dwyer, MA and Stankovich, J and Peterson, G and Greenfield, D and Si, L and Kinsman, L
Keywords: mental health; Demand; Crowding
Journal or Publication Title: BMC Health Services Research
Publisher: Biomed Central Ltd
ISSN: 1472-6963
DOI / ID Number:
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© The Author(s). 2018. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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