Patient-Level Predictors of Psychiatric Readmission in Substance Use Disorders

Abstract

Repeated psychiatric readmissions are a particular challenge in the treatment of substance use disorders and are associated with substantial burden for patients and their associates and for healthcare providers. Factors affecting readmission rates are heterogeneous and need to be identified to better allocate resources. Within the Swiss healthcare system, such data on substance use disorder patients are largely missing. Understanding these factors might bear important implications for future healthcare planning. Thus here, we examine risk factors of inpatient readmission. We retrospectively analyzed all admissions to the hospital's department of addictive disorders in the year 2016. Patients included in the study were followed over a period of 1 year after discharge regarding readmissions to the clinic. Besides the demographic, social, and economic data, we extracted data concerning patient history, admission, and discharge as well as clinical data regarding type and number of substances abused and comorbid diagnoses. In order to describe severity of cases, we furthermore included the scores of the Health of the Nation Outcome Scale (HoNOS) at admission and at discharge as documented in the medical database. Of the 554 patients included in the study, 228 (41.2%) were readmitted within 12 months. Previous admissions, concomitant use of different substances, presence of psychosis or mania, and a higher severity score at discharge increased the likelihood of readmission. The odds for readmission were furthermore higher in patients not being married, living alone, and being unemployed. When all (bivariate) statistically significant factors are included into a logistic regression model, the previous number of admissions and the HoNOS clinical score at discharge significantly contributed to this model. Our findings stress that patients with higher symptom load at discharge are prone to be readmitted within 12 months. The same applies for patients with previous admissions. These findings suggest that the development of specific interventions to prevent premature discharge before satisfactory symptom remission, in particular in those patients with previous admissions in their patient history, might help to prevent readmissions.

Pre-Discharge Predictors of 1-Year Rehospitalization in Adolescents and Young Adults with Severe Mental Disorders: A Retrospective Cohort Study

“…Furthermore, higher rates of readmission in individuals who started using drugs in their youth, compared to people who started later in their life, were estimated [ 24 ]. Our findings confirm that comorbid substance use disorders may lead to symptomatic relapse, impair clinical and psychosocial adjustment, reduce medication adherence, and lower the response to treatment among subjects with severe mental disorders [ 25 , 26 ]. As for suicidality, our analysis estimated that individuals who were admitted because of a suicide attempt were more likely to be rehospitalized, consistently with previous studies showing an association between suicidal behavior and readmission in both adolescents [ 9 , 12 ] and adults with early psychosis [ 27 ].…”

Predictors of Unplanned Readmissions Among Patients With Substance Use Disorders

“…However, readmissions are a common problem, 1,8,9 which underlines the importance of understanding risk factors of frequent hospital use among patients with SUD. In most cases patients with SUD can be treated adequately in outpatient programs.…”

“…However, another study including mainly patients with multiple SUDs found that the substance used did not influence readmissions. 9 The individual HoNOS items which may have allowed a more in-depth analysis of predictive factors were not considered in this analysis. Future studies could control for this.…”

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

“…For state hospital inpatients, the median length of stay was 34 days, whereas for patients hospitalized at other inpatient facilities, the median length of stay was only 7 days. Several prior studies have found that longer lengths of stay, or related measures such as adequate symptom resolution before discharge, are associated with a lower risk of readmission [e.g., 5,6,13,14]. Patients in other inpatient facilities may have been more likely to be readmitted because they received inadequate treatment while hospitalized.…”