The Revolving Door Phenomenon Revisited: Time to Readmission in 17’415 Patients with 37’697 Hospitalisations at a German Psychiatric Hospital

Abstract

ObjectiveDespite the recurring nature of the disease process in many psychiatric patients, individual careers and time to readmission rarely have been analysed by statistical models that incorporate sequence and velocity of recurrent hospitalisations. This study aims at comparing four statistical models specifically designed for recurrent event history analysis and evaluating the potential impact of predictor variables from different sources (patient, treatment process, social environment).MethodThe so called Andersen-Gil counting process model, two variants of the conditional models of Prentice, Williams, and Peterson (gap time model, conditional probability model), and the so called frailty model were applied to a dataset of 17’415 patients observed during a 12 years period starting from 1996 and leading to 37’697 psychiatric hospitalisations. Potential prognostic factors stem from a standardized patient documentation form.ResultsEstimated regression coefficients over different models were highly similar, but the frailty model best represented the sequentiality of individual treatment careers and differing velocities of disease progression. It also avoided otherwise likely misinterpretations of the impact of gender, partnership, historical time and length of stay. A widespread notion of psychiatric diseases as inevitably chronic and worsening could be rejected. Time in community was found to increase over historical time for all patients. Most important protective factors beyond diagnosis were employment, partnership, and sheltered living situation. Risky conditions were urban living and a concurrent substance use disorder.ConclusionPrognostic factors for course of diseases should be determined only by statistical models capable of adequately incorporating the recurrent nature of psychiatric illnesses.

Factors Associated with Psychiatric Readmissions: A Systematic Review

“…In four studies (15.3%), men presented higher rates and a greater trend towards readmission (Batalla et al, 2013;Castro et al, 2010;Lin et al, 2010;Pfiffner et al, 2014). On the other hand, being a woman appeared as a risk factor in five other studies (Byrne et al, 2010;Callaly et al, 2011;Frick et al, 2013;Kroken et al, 2012;Sánchez et al, 2013).…”

“…Three articles (11.5%) showed an association between lower income and higher number of readmissions (Jaramillo-Gonzalez et al, 2014;Lin et al, 2010;Sánchez et al, 2013) and one study found no association (Kikuchi et al, 2013). Where education is concerned, in the sample profiles, most participants had a low education level (Batalla et al, 2013;Castro et al, 2010;Dahlan et al, 2013;Frick et al, 2013;Pfiffner et al, 2014;Zhang et al, 2011). One study found a significant increase in readmissions in people with high education levels (Jaramillo-Gonzalez et al, 2014) and, in three studies, education was not a significant variable (Kikuchi et al, 2013;Lin et al, 2010;Moss et al, 2014).…”

“…Some surveys measured the time to readmission and the most risky period for this to happen. Regarding the average number of days between hospitalizations, the results varied between 90 (Schmutte et al, 2010) and 782 days (Frick et al, 2013). Analyzing the mean time to readmission in the 30 days following the discharge, the average found was 26.3 days and, for the later period, the mean was 99 days (Boaz et al, 2013).…”

Identifying Emerging Trends of Financial Business Method Patents

“…It is expected that PWP-GT can be a proper means of modeling the hot or cold status of a topic as PWP-GT considers that the subsequent event is conditional on the prior event [60]. The PWP-GT model is widely used in epidemiology, business, and medicine for analyzing the time gap of recurrent events [61][62][63][64].…”

The Development of the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS<sup>©</sup>)

“…Psychiatric disease does not only exhibit subjective symptomatology, but also includes functional disturbances, disability and social disadvantage [3]- [5]. Characteristics of psychiatric diseases are that the progression and remission repeatedly occur and the disease becomes chronic [6] forcing psychiatric patients to continually stay in hospitals rather than live in their communities [7] [8].…”