Mental health professionals usually decide patients’ access to inpatient care to ensure the rational and fair distribution of care based on need and prognosis. The purpose of the current study is to investigate the effects of increasing patients’ influence on admission by enabling patients to initiate brief inpatient stays of up to five days at a community mental health center. Patients can initiate admission according to their own discretion, outside the existing referral and gatekeeping system. Patient-controlled admission (PCA) contracts were offered to eligible patients for inpatient stays in four community mental health centers in one health trust in Norway. Data on included patients’ inpatient stays at any of the hospitals’ mental health or addiction wards were collected by hospital electronic journal data extraction specialists for the two years before PCA contracts were introduced and the first two years after PCA contracts were introduced for the included patients. The included patients (n = 57) had 406 PCAs in the two years following signing PCA contracts. When comparing the periods before and after the introduction of the contracts, the total number of admissions increased from 203 to 498 (p < .001), while the number of inpatient days decreased from 7172 to 3178 (p < .001). No significant change in involuntary care was observed. A comparison of box plots of inpatient day use in the eight half-year periods of the study indicates a gradual increase in median inpatient days up to the signing of a PCA contract for the sample, and an abrupt reduction to a stable median level of inpatient days after signing a contract. The included patients’ use of inpatient days changed profoundly after signing PCA contracts, similar to what previous studies of PCAs have indicated. In spite of the marked reductions in inpatient days, the pre-post design makes it impossible to rule out that the reductions were caused by regression toward the mean. No study of PCAs has reported negative effects, indicating that giving patients control over very short admissions is a feasible and potentially positive scheme in mental health care wards.

中文翻译：

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当患者决定入院时——对患者控制入院合同后的入院和住院天数变化进行四年的事前研究

精神卫生专业人员通常决定患者获得住院护理的机会，以确保根据需求和预后合理、公平地分配护理。本研究的目的是调查通过让患者在社区精神卫生中心开始长达五天的短暂住院治疗来增加患者对入院的影响的效果。患者可以在现有的转诊和把关系统之外自行决定入院。挪威一个健康信托基金的四个社区精神卫生中心向符合条件的患者提供患者控制入院（PCA）合同。医院电子期刊数据提取专家收集了纳入的患者在任何一家医院的精神健康或成瘾病房住院的数据，这些数据是在引入 PCA 合同之前的两年以及引入 PCA 合同之后的前两年为纳入的患者收集的。 。纳入的患者 (n = 57) 在签署 PCA 合同后的两年内进行了 406 次 PCA。比较合同实施前后的时期，入院总人数从 203 人增加到 498 人 (p < .001)，而住院天数从 7172 人减少到 3178 人 (p < .001)。没有观察到非自愿护理的显着变化。对研究的八个半年期间住院天数使用的箱线图进行比较表明，在签署样本 PCA 合同之前，中位住院天数逐渐增加，并突然减少至稳定的住院中位天数签订合同后几天。签署 PCA 合同后，纳入的患者住院天数的使用情况发生了深刻变化，与之前的 PCA 研究表明的情况类似。尽管住院天数显着减少，但前后设计无法排除住院天数减少是由均值回归引起的。没有任何关于 PCA 的研究报告过负面影响，这表明在精神卫生保健病房中让患者控制非常短的入院时间是一种可行且可能积极的方案。