Pre-discharge factors predicting readmissions of psychiatric patients: a systematic review of the literature

Abstract

BackgroundReadmission rate is considered an indicator of the mental health care quality. Previous studies have examined a number of factors that are likely to influence readmission. The main objective of this systematic review is to identify the studied pre-discharge variables and describe their relevance to readmission among psychiatric patients.MethodsStudies on the association between pre-discharge variables and readmission after discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. Relevant publications published between January 1990 and June 2014 were included. For each variable, the number of papers that considered it as a predictor of readmission and that found a significant association was recorded, together with the association direction and whether it was found respectively in bivariate and in multivariate analyses.ResultsOf the 734 articles identified in the search, 58 papers were included in this review, mainly from the USA and concerning patients with severe mental disorders. Analysed variables were classified according to the following categories: patients’ demographic, social and economic characteristics; patients’ clinical characteristics; patients’ clinical history; patients’ attitude and perception; environmental, social and hospital characteristics; and admission and discharge characteristics. The most consistently significant predictor of readmission was previous hospitalisations. Many socio-demographic variables resulted as influencing readmission, but the results were not always homogeneous. Among other patients’ clinical characteristics, diagnosis and measures of functional status were the most often used variables. Among admission characteristics, length of stay was the main factor studied; however, the results were not very consistent. Other relevant aspects resulted associated with readmission, including the presence of social support, but they have been considered only in few papers. Results of quality assessment are also reported in the review. The majority of papers were not representative of the general psychiatric population discharged from an inpatient service. Almost all studies used multivariate analytical methods, i.e., confounders were controlled for, but only around 60% adjusted for previous hospitalisation, the variable most consistently considered associated to readmission in the literature.ConclusionsThe results contribute to increase knowledge on pre-discharge factors that could be considered by researchers as well as by clinicians to predict and prevent readmissions of psychiatric patients. Associations are not always straightforward and interactions between factors have to be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1114-0) contains supplementary material, which is available to authorized users.

Mentally disordered offenders discharged from designated hospital facilities under the medical treatment and supervision act in Japan: Reoffending and readmission

“…They were particularly likely among patients who had required a transitionary period in a local hospital before discharge to the community. Donisi, Tedeschi, Wahlbeck, Haaramo, and Amaddeo (2016), reviewing predischarge factors and readmission, found that the most consistent significant predictor of readmission was prior hospitalisation-which was consistent with our findings. In addition, our readmission rate of offender patients with substance misuse disorders was high, also fitting with the result of previous reports (Donisi et al, 2016;Mark et al, 2013).…”

“…Donisi, Tedeschi, Wahlbeck, Haaramo, and Amaddeo (2016), reviewing predischarge factors and readmission, found that the most consistent significant predictor of readmission was prior hospitalisation-which was consistent with our findings. In addition, our readmission rate of offender patients with substance misuse disorders was high, also fitting with the result of previous reports (Donisi et al, 2016;Mark et al, 2013). Although we do not have all details for the local hospital readmissions, it is perhaps worth emphasising that a hospital admission is not necessarily an indication of failure.…”

Patient-Level Predictors of Psychiatric Readmission in Substance Use Disorders

“…With regard to the marital status, a recent review pointed out that being married generally appears to be a protective factor against readmission of patients suffering from psychiatric diseases (11). According to the literature, this observation also applies to readmission in SUD (20)(21)(22).…”

“…Understanding factors that predict readmission would allow to better address the specific needs of the population at risk and to prevent costly inpatient treatment. In addition, readmission rates might serve as an indicator of the quality of care and could therefore be of particular relevance for healthcare policy makers (11). Finally, previous readmission rates in SUD are often considered to be a significant predictor of further relapse after inpatient treatment.…”

“…From a recent review on pre-discharge factors of readmission in general psychiatric patients, we know that the most consistent factor predicting readmission appears to be a previous hospitalization (11). With regard to SUDs, further factors have been reported in various studies.…”