Risk factors for acute psychiatric readmission

Dixon, Mandy; Robertson, E C; George, Mohan; Oyebode, Femi

doi:10.1192/pb.21.10.600

Cited by 16 publications

(13 citation statements)

References 11 publications

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“…Living in care (vs alone or with family) was found as a protective factor in Dixon et al [30], and Russo et al [59] found homelessness as a risk factor at bivariate level, while living alone was found as protective in Priebe [14] and in Adams [60]. In Ono et al [18], the variable “number of cohabitants” was considered, a larger number turning out to be a protective factor for readmission.…”

Section: Categories Of Pre-discharge Variables Analysedmentioning

confidence: 99%

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%

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

et al. 2016

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“…Four known previous studies have investigated factors that predict re-admission to a psychiatric hospital within the United Kingdom (Hodgson et al, 2001;Langdon et al, 2001;Dixon, Robertson, George, & Oyebode, 1997;Tyrer et al, 1995). Hodgson et al (2001) examined data on admissions in an area of Britain from 1987 to 1993 and reported higher re-admission rates for those who were unmarried, had a diagnosis of psychotic disorder, detained under sections of the Mental Health Act, or had a shorter length of stay during their index admission.…”

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confidence: 98%

“…Hodgson et al (2001) examined data on admissions in an area of Britain from 1987 to 1993 and reported higher re-admission rates for those who were unmarried, had a diagnosis of psychotic disorder, detained under sections of the Mental Health Act, or had a shorter length of stay during their index admission. Dixon et al (1997) examined factors that were related to re-admission to hospital within six months of discharge. They reported that having more prior admissions, living alone or with family, and being discharged against medical advice predicted re-admission.…”

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confidence: 99%

Factors associated with multiple re-admission to a psychiatric hospital

Webb

Yágüez

Langdon

2007

Journal of Mental Health

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Background: Previous studies have attempted to identify various demographic and associated factors which place psychiatric service users at risk of re-admission to a psychiatric hospital following discharge. Aims: To conduct a 2-year follow-up of a group of patients who had been admitted to a psychiatric ward and to investigate possible variables that could determine readmission to hospital. Method: A cross sectional and a two year longitudinal design were used. Results: ''Revolving-door'' service users were more likely to be taking medication, were younger at age of first contact with services, and had been using services for longer. They were also more likely to be living in council housing, which is, housing provided by and subsidised by local government, and have a diagnosis of affective disorder. There were no differences between the previous cohort and the current sample in terms of demographics, and history of contact with services. A larger proportion of service users met the ''revolving-door'' criteria during the present study as compared to our previous study. There were some differences between the current and previous study in terms of accommodation at discharge, diagnosis, and social living status. Conclusions: Several variables were shown to predict membership in the ''revolving-door'' group and findings replicate Langdon et al. (2001), although there were differences. ''Revolving-door'' patients may have more enduring and chronic mental illnesses, but were similar to their ''non-revolving door'' counterparts on some variables. Research of this nature is difficult given the cross-sectional nature of studies, and a lack of a clear consensus within the literature as to which factors are associated with ''revolving-door'' service users remains. Declaration of interest: None.

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“…17 Of particular concern is the impact of current pressure to shorten length of hospital stay, which is hypothesized to result in premature discharge and put the patient at risk of readmission. [18][19][20] If readmission is to be considered an indicator of the quality of hospital care, it should be actionable by hospitals, that is, a change in hospital practice should influence the indicator result. 21 Furthermore, the authors should be able to offer some guidelines on acceptable results.…”

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confidence: 99%

Is Readmission a Valid Indicator of the Quality of Inpatient Psychiatric Care?

Durbin

Lin

Layne

et al. 2007

J Behav Health Serv Res

144

127

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Early return to hospital is a frequently measured outcome in mental health system performance monitoring yet its validity for evaluating quality of inpatient care is unclear. This study reviewed research conducted in the last decade on predictors of early readmission (within 30 to 90 days of discharge) to assess the association between this indicator and quality of inpatient psychiatric care. Only 13 studies met inclusion criteria. Results indicated that risk is greatest in the 30-day period immediately after discharge. There was modest support that attending to stability of clinical condition and preparing patients for discharge can protect against early readmission. A history of repeated admission increases risk, suggesting that special efforts are required to break the revolving door cycle. The authors identified a need for more standardization in measurement of client status at discharge and related care processes, more intervention studies on discharge practices, and studies of the effect of community care on early readmission.

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Risk factors for acute psychiatric readmission

Cited by 16 publications

References 11 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

Factors associated with multiple re-admission to a psychiatric hospital

Is Readmission a Valid Indicator of the Quality of Inpatient Psychiatric Care?

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