Hospital Readmission Among Medicaid Patients with an Index Hospitalization for Mental and/or Substance Use Disorder

Abstract

Hospital readmission rates are increasingly used as a performance indicator. Whether they are a valid, reliable, and actionable measure for behavioral health is unknown. Using the MarketScan Multistate Medicaid Claims Database, this study examined hospital- and patient-level predictors of behavioral health readmission rates. Among hospitals with at least 25 annual admissions, the median behavioral health readmission rate was 11% (10th percentile, 3%; 90th percentile, 18%). Increased follow-up at community mental health centers was associated with lower probabilities of readmission, although follow-up with other types of providers was not significantly associated with hospital readmissions. Hospital average length of stay was positively associated with lower readmission rates; however, the effect size was small. Patients with a prior inpatient stay, a substance use disorder, psychotic illness, and medical comorbidities were more likely to be readmitted. Additional research is needed to further understand how the provision of inpatient services and post-discharge follow-up influence readmissions.

Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?

“…A recent study examined readmission rates for mental health and/or substance use disorder among a national sample of Medicaid enrollees from 2004-2009. Among 121,271 discharges, they found that 46% had any follow-up in 7 days, but only 7.4 % and 11.4% had follow-up with a psychiatrist or community mental health center respectively [29]. Although these results represent a broader population group and are not directly comparable to our findings, they similarly reflect lower rates of follow-up with primary care and mental health providers post hospital discharge.…”

Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature

“…They can further be divided into studies capturing potential hospital size effects [14–17], capacity variables [18–23], resource availability/utilisation/ quality [14, 17, 24, 25], length of stay [14, 16–18, 20], case-mix [14, 20], treatment policies or orientation [14, 16, 17, 26], hospital type [24, 25, 27, 28] and community aftercare [14, 16, 17, 29–36]. …”

“…Hospital length of stay is consistently found to be negatively related to (risk/rate of) readmission when measured both at hospital level or community level [14, 16–18, 20]. Heggestad [24] also found that high patient turnover (annual discharges/beds) increased the likelihood of readmissions.…”

Understanding Patterns Of High-Cost Health Care Use Across Different Substance User Groups

“…Previous studies have documented the link between substance use diagnoses and hospitalization or readmission in Medicaid 14,15,17 and in smaller samples, 30 and the link between those diagnoses and admissions nationally known to be directly related to drug use. 22,23 Our study extends the literature by examining hospitalizations across relatively nuanced substance use profiles in a large nationally representative sample.…”