Admission Volume and Quality of Mental Health Care Among Danish Patients With Recently Diagnosed Schizophrenia

OBJECTIVE: The relationship between admission volume and the quality of mental health care remains unclear. This study examined the association between admission volume of psychiatric hospital units and quality of mental health care among patients with recently diagnosed schizophrenia (past year) admitted to units in Denmark.

METHODS: In a nationwide population-based cohort study, 3,209 patients admitted to psychiatric hospital units between 2004 and 2011 were identified from the Danish Schizophrenia Registry. Admission volume was categorized into four quartiles according to the individual unit's average caseload volume per year during the study period: low volume (quartile 1, ≤75 admissions per year), medium volume (quartile 2, 76-146 admissions per year), high volume (quartile 3, 147-256 admissions per year) and very high volume (quartile 4, >256 admissions per year). Quality of mental health care was defined as having received processes of care recommended in guidelines.

RESULTS: Compared with patients admitted to low-volume psychiatric hospital units, patients admitted to very-high-volume units were more likely to receive high overall quality of mental health care (≥80% of recommended processes of care) (risk ratio [RR]=1.40, 95% confidence interval [CI]=1.03-1.91) and to receive several specific processes of care, including assessment of psychopathology by a specialist in psychiatry (RR=1.05, CI=1.01-1.10) and psychoeducation (RR=1.16, CI=1.05-1.28). Moreover, patients admitted to high-volume units were more likely to have a suicide risk assessment at discharge (RR=1.14, CI=1.07-1.21).

CONCLUSIONS: Admission to very-high-volume and high-volume psychiatric hospital units was associated with a greater chance of receiving guideline-recommended processes of care among patients admitted with recently diagnosed schizophrenia.