Follow-up Psychiatric Care and Risk of Readmission in Patients with Serious Mental Illness in State Funded or Operated Facilities

Abstract

Receipt of outpatient treatment within 30 days of discharge from psychiatric hospitalization is an established quality indicator; however, there is scant, mixed evidence as to whether it reduces the risk of readmission. We evaluated this question in patients hospitalized for schizophrenic, bipolar or depressive disorders using the Mental Health Treatment Episode Data Set (MH-TEDS), comprising patients in state-funded or -operated facilities and programs. We performed a 6-month, retrospective longitudinal cohort study including 44,761 patients with schizophrenic disorders, 45,413 patients with bipolar disorders, and 74,995 patients with depressive disorders with an index hospitalization between 2014 and 2018, stratified by whether they had at least one outpatient treatment admission in the first 30 days post-discharge. We used multivariable logistic regression to assess risk of readmission during days 31–180. We found that less than 10 percent of patients in the three cohorts received the recommended follow-up outpatient care. Furthermore, we found that schizophrenic and bipolar patients who did receive such care were no less likely to be readmitted than those not receiving such care (AOR = 0.96, 95% CI 0.87–1.06; AOR 1.06, 955 CI 0.98–1.14), and patients with depressive disorders receiving such care were more likely to be readmitted (AOR = 1.14, 95% CI 1.07–1.22). Thus, few patients received follow-up outpatient care within 30 days of discharge. When it occurred, such outpatient care was either not linked to reduced readmissions or was associated with increased readmissions. These findings suggest the need for more effective care processes in state-funded or -operated facilities.

Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias

“…Within 30 days after discharge from a psychiatric inpatient episode around one in six patients (17.3%) visited an office psychiatrist. This is more towards the lower end of the large range reported for visits to psychiatric outpatient services within 30 days post‐discharge in different health care systems, such as 9.1% for patients with schizophrenia, bipolar disorder and depression in state funded or operated mental health facilities in the USA (Hermer et al., 2022 ), 44% for schizophrenia in Canada (Kurdyak et al., 2018 ), 55.1% for any mental disorder in the national health service system in Italy (Donisi, Tedeschi, Salazzari, et al., 2016 ) and 85.1% for schizophrenia in Japan (Okumura et al., 2018 ). Such rates are not easily comparable, but it is of interest that in the Canadian study (Kurdyak et al., 2018 ) a comparison was performed between post‐discharge psychiatric and GP contacts, a comparison we were also able to perform.…”

“…These results were obtained by using Cox regression with time‐dependent covariates, thereby avoiding the immortal time bias. This approach allowed to include also early re‐hospitalisations, which are a substantial fraction of total re‐hospitalisations, but are omitted in published registry‐based retrospective cohort studies on the association of early post‐discharge ambulatory contacts with psychiatric re‐hospitalisation (Beadles et al., 2015 ; Donisi, Tedeschi, Salazzari, et al., 2016 ; Hermer et al., 2022 ; Kurdyak et al., 2018 ; Lee et al., 2015 ; Marcus et al., 2017 ; Okumura et al., 2018 ).…”

“…A whole series of recent retrospective cohort studies on psychiatric re‐hospitalisation used large, often nationwide electronic databases for collecting information about outpatient contacts in the first weeks (mostly 30 days) after the index discharge from psychiatric hospitalisation, but examined the association of such early contacts only with re‐hospitalisations during the (mostly six) months after the critical early period (Beadles et al., 2015 ; Donisi, Tedeschi, Salazzari, et al., 2016 ; Hermer et al., 2022 ; Kurdyak et al., 2018 ; Lee et al., 2015 ; Marcus et al., 2017 ; Okumura et al., 2018 ). Findings were mixed.…”

Follow-Up Timing After Discharge and Suicide Risk Among Patients Hospitalized With Psychiatric Illness

“…A retrospective cohort study of schizophrenia and bipolar disorder found that outpatient follow-ups within 30 days after discharge were associated with slightly lower readmission risk . Another study revealed that patients who received timely follow-up visits had lower readmission rates in Japan and the US . Some studies examining the association between early outpatient follow-up after discharge and suicide risk have been published.…”

Post Hospitalization Clinical Quality Outcomes Among US Patients with Schizophrenia Treated with a Long-Acting Injectable or Switched to a New Oral Antipsychotic: A Retrospective Cohort Study

“…Receiving timely follow-up care after hospital discharge is critical, given that patients with a recent hospitalization and their caregivers are particularly vulnerable during this time [8]. Lack of timely follow-up care when a patient transitions from the inpatient setting to outpatient care can result in medication discontinuation, rehospitalization, and other negative outcomes, such as poor symptom control, relapse, and impacts on families and caregivers [9][10][11][12].…”