Predicting readmission to the psychiatric hospital in a managed care environment: implications for quality indicators

Lyons, John S.; O'Mahoney, Michael T.; Miller, Sheldon I.; Neme, Janice; Kabat, Julie; Miller, Frederick J.

doi:10.1176/ajp.154.3.337

Cited by 164 publications

(24 citation statements)

References 10 publications

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“…In terms of suicide , in Lyons [7] suicide potential as a reason of admission decreased the risk of readmission at 1 year, but not at 30 days or at 6 months. In Kim et al [26] a history of suicide attempt increased the risk of readmission in one paper at bivariate analysis, but resulted not significant in other two papers [48, 58].…”

Section: Categories Of Pre-discharge Variables Analysedmentioning

confidence: 99%

“…In Lyons et al [7] using “the Severity of Psychiatric Illness scale” and “The Acuity of Psychiatric Illness scale”, the 30-day readmission risk increased for higher level of self-care impairment, 6-month readmission risk for higher clinical status scores at admission and higher level of severity of symptoms and 1-year readmission risk for self-care impairment, severity of symptoms and premorbid dysfunction level.…”

Section: Categories Of Pre-discharge Variables Analysedmentioning

confidence: 99%

“…At bivariate level, criticism of family member and caregiver’s over-estimation of their own ability to provide assistance and emotional support, more family involvement, attendance of a carer at the discharge planning, perceived treatment support reported significant results [7, 25, 35, 37, 40, 57]. On the contrary, presence and extent of social support network, pre-discharge contacts with family or non-government psychosocial support organisations, change in the support system preceding hospitalisation and family conflict resulted non-significant.…”

Section: Categories Of Pre-discharge Variables Analysedmentioning

confidence: 99%

“…In psychiatry, readmission rates are widely used as a proxy for relapse or complications following an inpatient stay, indicating either premature discharge from an inpatient psychiatric ward or lack of coordination with or follow-up by outpatient facilities. Nevertheless, the associations of inpatient and community factors with readmission are far from consistent [4–7]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Categories Of Pre-discharge Variables Analysedmentioning

confidence: 99%

Section: Categories Of Pre-discharge Variables Analysedmentioning

confidence: 99%

Section: Categories Of Pre-discharge Variables Analysedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…The “quicker-but-sicker” hypothesis has been studied extensively in general medicine (Qian et al 2010; Moore et al 2007; Halm et al 2002; Kosecoff et al 1990) and inpatient psychiatry (McFarland et al 2002; Lyons et al 1997; Ellis and McGuire 1996; Appleby et al 1993). However, no prior study has evaluated whether state psychiatric hospital waitlist policies are producing this effect.…”

Section: Introductionmentioning

confidence: 99%

The Effects of State Psychiatric Hospital Waitlist Policies on Length of Stay and Time to Readmission

Zhu

Lich

et al. 2014

Adm Policy Ment Health

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This study examined the effects of a waitlist policy for state psychiatric hospitals on length of stay and time to readmission using data from North Carolina for 2004–2010. Cox proportional hazards models tested the hypothesis that patients were discharged “quicker-but-sicker” post-waitlist, as hospitals struggled to manage admission delays and quickly admit waitlisted patients. Results refute this hypothesis, indicating that waitlists were associated with increased length of stay and time to readmission. Further research is needed to evaluate patients’ clinical outcomes directly and to examine the impact of state hospital waitlists in other areas, such as state hospital case mix, local emergency departments, and outpatient mental health agencies.

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Trends in the Inpatient Mental Health Treatment of Children and Adolescents in US Community Hospitals Between 1990 and 2000

Case¹,

Olfson²,

Marcus³

et al. 2007

Arch Gen Psychiatry

126

101

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Predicting readmission to the psychiatric hospital in a managed care environment: implications for quality indicators

Cited by 164 publications

References 10 publications

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

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

The Effects of State Psychiatric Hospital Waitlist Policies on Length of Stay and Time to Readmission

Trends in the Inpatient Mental Health Treatment of Children and Adolescents in US Community Hospitals Between 1990 and 2000

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