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Herrera-Imbroda J, Guzmán-Parra J, Bordallo-Aragón A, Moreno-Küstner B, Mayoral-Cleríes F. Risk of psychiatric readmission in the homeless population: A 10-year follow-up study. Front Psychol 2023; 14:1128158. [PMID: 36874811 PMCID: PMC9975390 DOI: 10.3389/fpsyg.2023.1128158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
Homelessness continues to be a major social and clinical problem. The homeless population has a higher burden of disease that includes psychiatric disorders. In addition, they have a lower use of ambulatory health services and a higher use of acute care. Few investigations analyze the use of services of this population group in the long term. We analyzed the risk of psychiatric readmission of homeless individuals through survival analysis. All admissions to a mental health hospitalization unit in the city of Malaga, Spain, from 1999 to 2005, have been analyzed. Three analyses were carried out: two intermediate analyses at 30 days and 1 year after starting follow-up; and one final analysis at 10 years. In all cases, the event was readmission to the hospitalization unit. The adjusted Hazard Ratio at 30 days, 1-year, and 10-year follow-ups were 1.387 (p = 0.027), 1.015 (p = 0.890), and 0.826 (p = 0.043), respectively. We have found an increased risk of readmission for the homeless population at 30 days and a decreased risk of readmission at 10 years. We hypothesize that this lower risk of long-term readmission may be due to the high mobility of the homeless population, its low degree of adherence to long-term mental health services, and its high mortality rate. We suggest that time-critical intervention programs in the short term could decrease the high rate of early readmission of the homeless population, and long-term interventions could link them with services and avoid its dispersion and abandonment.
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Affiliation(s)
- Jesús Herrera-Imbroda
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain.,Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Andalucía Tech, Málaga, Spain
| | - José Guzmán-Parra
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Bordallo-Aragón
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Berta Moreno-Küstner
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain.,Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Andalucía Tech, Málaga, Spain
| | - Fermín Mayoral-Cleríes
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
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Katsuta N, Ohnuma T, Ito M, Nishimon S, Takeda M, Sannohe T, Tani E, Miki Y, Nakamura T, Yamashita H, Nakadaira M, Arai H. Effects of Age and Anxiety on Short-Term Rehospitalization Rates in Japanese Patients with Schizophrenia. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200603-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Partial hospitalization is an understudied bridge between outpatient and inpatient care. One of its primary functions is to prevent the need for inpatient hospitalization. We examined potential demographic and clinical risk factors for inpatient hospitalization for current partial hospital patients. We conducted separate multiple logistic regression analyses for patients referred from inpatient care and the community. For individuals referred from inpatient care, suicidal ideation and greater psychotic symptoms upon admission to the partial program were associated with acute inpatient re-hospitalization. For individuals referred from the community, suicidal ideation and worse relationship functioning upon partial hospital admission were significant risk factors for inpatient hospitalization. Number of previous inpatient hospitalizations and greater substance abuse were not associated with inpatient hospitalization in either sample. Implications at the provider and program level are discussed.
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Etxeberria-Lekuona D, Casas Fernández de Tejerina J, Méndez López I, Oteiza Olaso J, Arteaga Mazuelas M, Jarne Betran V. Multiple hospitalizations at the department of internal medicine of a tertiary hospital. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Etxeberria-Lekuona D, Casas Fernández de Tejerina JM, Méndez López I, Oteiza Olaso J, Arteaga Mazuelas M, Jarne Betran V. Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital. Rev Clin Esp 2014; 215:9-17. [PMID: 25278435 DOI: 10.1016/j.rce.2014.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/27/2014] [Accepted: 08/18/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. PATIENTS AND METHODS A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. RESULTS When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. CONCLUSIONS Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.
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Affiliation(s)
- D Etxeberria-Lekuona
- Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | | | - I Méndez López
- Servicio de Medicina Interna, Hospital García Orcoyen, Estella, Navarra, España
| | - J Oteiza Olaso
- Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M Arteaga Mazuelas
- Servicio de Medicina Interna, Hospital García Orcoyen, Estella, Navarra, España
| | - V Jarne Betran
- Servicio de Medicina Interna, Hospital García Orcoyen, Estella, Navarra, España
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[Heavy users of inpatient services: a comparison of diagnostic subgroups]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2014; 28:169-77. [PMID: 25073952 DOI: 10.1007/s40211-014-0113-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Quantitative and qualitative assessment of heavy users (HU) of psychiatric inpatient treatment. METHODS Screening over 9 months for patients with ≥ 3 admissions or ≥ 100 days of treatment during 1 year prior to index admission. RESULTS During the recruiting period 1217 persons were treated of whom 132 (10.8 %) fulfilled HU criteria. Patients belonged most often to the diagnostic group F2 (43 %), followed by F1 (21 %) and F3 (17 %). HU were most common within the diagnostic group F6 (33 %), next to F2 (21 %), F1 (9 %) and F3 (6 %). HU had signs of more severe illness compared to the other patients: only 8 % held a job and 73 % ware on a disablement pension, patients with a diagnosis of F2 faring worst. HU were treated more frequently involuntarily (50.5 vs 30.7 %). An office-based physician referred only 5 % of the patients and almost half attended the clinic without any referral. HU participated only to a modest degree in community-based treatments and 37 % attended no doctor in the month prior to admission. During the year following the index admission more than 80 % of HU were admitted again and were hospitalized almost as many days as before the index admission. Patients with a diagnosis of F1 and F2 showed the greatest persistence of heavy use behavior. CONCLUSIONS This sample of HU show a persistent pattern of use of psychiatric inpatient treatment. Strategies to improve the situation are discussed.
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Post-inpatient attrition from care "as usual" in veterans with multiple psychiatric admissions. Community Ment Health J 2013; 49:694-703. [PMID: 23086009 DOI: 10.1007/s10597-012-9544-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
Disengagement from outpatient care following psychiatric hospitalization is common in high-utilizing psychiatric patients and contributes to intensive care utilization. To investigate variables related to treatment attrition, a range of demographic, diagnostic, cognitive, social, and behavioral variables were collected from 233 veterans receiving inpatient psychiatric services who were then monitored over the following 2 years. During the follow-up period, 88.0 % (n = 202) of patients disengaged from post-inpatient care. Attrition was associated with male gender, younger age, increased expectations of stigma, less short-term participation in group therapy, and poorer medication adherence. Of those who left care, earlier attrition was predicted by fewer prior-year inpatient psychiatric days, fewer lifetime psychiatric hospitalizations, increased perceived treatment support from family, and less short-term attendance at psychiatrist appointments. Survival analyses were used to analyze the rate of attrition of the entire sample as well as the sample split by short-term group therapy attendance. Implications are discussed.
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Rothbard AB, Chhatre S, Zubritsky C, Fortuna K, Dettwyler S, Henry RJ, Smith M. Effectiveness of a high end users program for persons with psychiatric disorders. Community Ment Health J 2012; 48:598-603. [PMID: 22290303 DOI: 10.1007/s10597-012-9479-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/13/2012] [Indexed: 11/28/2022]
Abstract
To evaluate the effectiveness of an intensive system of case management for high end users of inpatient care in reducing psychiatric inpatient utilization. A prepost study design with a contemporaneous comparison group was employed to determine the effects of a State designed intervention to reduce inpatient care for adults with a mental health disorder who had high utilization of inpatient psychiatric care between 2004 and 2007. Logit and negative binomial regression models were used to determine the likelihood, frequency and total days of inpatient utilization in the post period as a function of the intervention. Data from administrative reporting forms and Medicaid claims were used to construct inpatient utilization histories and characteristics of 176 patients. Patients in both groups had a significant reduction in mean inpatient days. However, being in the intervention program did not result in lower odds of being re-hospitalized or in fewer episodes during the study period.
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Affiliation(s)
- Aileen B Rothbard
- Center for Mental Health Policy and Service Research, 3535 Market St., Room 3014, Philadelphia, PA 19104-2648, USA.
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Martínez-Ortega JM, Gutiérrez-Rojas L, Jurado D, Higueras A, Diaz FJ, Gurpegui M. Factors associated with frequent psychiatric admissions in a general hospital in Spain. Int J Soc Psychiatry 2012; 58:532-5. [PMID: 21724657 DOI: 10.1177/0020764011413061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify demographic or clinical factors associated with frequent admissions in a sample of patients admitted to an acute psychiatric hospitalization unit, controlling for potentially confounding factors. METHODS Socio-demographic variables, diagnosis, and the legal status, date and length of admission were collected for 1,722 consecutively admitted psychiatric patients during a period of up to eight years (1998-2005). Frequently admitted patients were defined as undergoing one or more admissions per year on average. RESULTS After controlling for potential confounding factors, logistic regression showed that being a frequently admitted patient was significantly associated with diagnoses of schizoaffective disorder, personality disorder or schizophrenia; an involuntary commitment at first admission; and younger age. CONCLUSIONS Factors associated with frequently admitted patients should be identified in order to establish more effective strategies for preventing relapse.
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Martínez-Ortega JM, Jurado D, Gutiérrez-Rojas L, Molero P, Ramos MA, Gurpegui M. Stability of sex differences by diagnosis in psychiatric hospitalizations. Psychiatry Res 2012; 198:161-3. [PMID: 22397920 DOI: 10.1016/j.psychres.2011.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 10/05/2011] [Accepted: 11/26/2011] [Indexed: 10/28/2022]
Abstract
We examined sex differences in the distribution of psychiatric diagnoses among hospitalized patients, controlling for socio-demographic variables. The sample included 1865 psychiatric inpatients consecutively admitted during a 9-year period. The finding of a higher proportion of men among patients hospitalized for schizophrenia or substance use disorder and a higher proportion of women among those admitted for affective disorders, including bipolar disorder, was stable over time. A better understanding of these differences may help to establish more effective treatment strategies.
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Affiliation(s)
- José M Martínez-Ortega
- Department of Psychiatry, Faculty of Medicine, University of Granada, Av. Madrid 11, E-18071 Granada, Spain.
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Gaddini A, Franco F, Di Lallo D, Biscaglia L. Hospitalisation for schizophrenia in acute psychiatric wards of the Lazio region: a 4-year follow-up study. Epidemiol Psychiatr Sci 2011; 14:227-34. [PMID: 16396430 DOI: 10.1017/s1121189x00007971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYAim – To determine the rates of psychiatric hospitalisation and to evaluate the predictors of readmissions in a cohort of 887 schizophrenic patients at their “first” psychiatric admission. Methods – Data were collected using the hospital dis-charge database of the Lazio region, Italy. The cohort included patients admitted to a psychiatric ward in 1999, with a main diagnosis of schizophrenia and no prior psychiatric hospitalisation during the 5 years preceding the index admission. Psychiatric read-missions were considered up to year 2004. Kaplan-Meier survival curves and logistic procedures were performed to estimate the cumulative readmission incidence and ORs of readmissions for potential confounders. Results – During the 4-year follow-up, 44.3% of the patients were readmitted at least once. An active treatment among community psychiatric facilities at the time of index admission predicted a higher readmission risk. However, for those who experienced their first admission in a private ward read-mission risk was consistently higher, whether or not having had such a treatment. Conclusions – Risk of readmission in a psychiatric ward appears to be related to the level of integration with mental health community facilities, while length of stay is strongly affected by service system variables. Possible uses of medical information systems in this field are described.Declaration of Interest: none.
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Lin CH, Chen WL, Lin CM, Lee MD, Ko MC, Li CY. Predictors of psychiatric readmissions in the short- and long-term: a population-based study in Taiwan. Clinics (Sao Paulo) 2010; 65:481-9. [PMID: 20535366 PMCID: PMC2882542 DOI: 10.1590/s1807-59322010000500005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 01/27/2010] [Accepted: 02/17/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To explore the risks and rates of readmission and their predictors 14 days, one year, and five years after discharge for the psychiatric population in Taiwan. METHODS This was a prospective study based on claims from 44,237 first-time hospitalized psychiatric patients discharged in 2000, who were followed for up to five years after discharge. The cumulative incidence and incidence density of readmission were calculated for various follow-up periods after discharge, and Cox proportional hazard models were generated to identify the significant predictors for psychiatric readmission. RESULTS The less than 14-day, one-year, and five-year cumulative incidences were estimated at 6.1%, 22.3%, and 37.8%, respectively. The corresponding figures for incidence density were 4.58, 1.04, and 0.69 per 1,000 person-days, respectively. Certain factors were significantly associated with increased risk of readmission irrespective of the length of follow-up, including male gender, length of hospital stay >15 days, economic poverty, a leading discharge diagnosis of schizophrenia/affective disorders, and residence in less-urbanized regions. Compared to children/adolescents, young adults (20-39 years) were significantly associated with increased risks of CONCLUSIONS This study found that the significant predictors for psychiatric readmission 14 days to five years after discharge were essentially the same except for patient's age and hospital accreditation level. This study also highlighted the importance of socioeconomic factors in the prediction of readmission.
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Affiliation(s)
- Chuan-Hsiung Lin
- Department of Health Care Administration, Central Taiwan University of Science and Technology - Taichung, Taiwan
| | - Wen-Ling Chen
- Department of Health Care Management, National Taipei College of Nursing - Taipei, Taiwan
| | - Chih-Ming Lin
- Department of Healthcare Information and Management, Ming Chuan University - Taoyuan County, Taiwan
| | - Ming-Der Lee
- Graduate Institute of Long-Term Care, National Taipei College of Nursing, - Taipei, Taiwan
| | - Ming-Chung Ko
- Department of Surgery, Taipei City Hospital - Taipei, Taiwan.,
| | - Chung-Yi Li
- Department of Health Care Management, National Taipei College of Nursing - Taipei, Taiwan
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Webb S, Yágüez L, Langdon PE. Factors associated with multiple re-admission to a psychiatric hospital. J Ment Health 2009. [DOI: 10.1080/09638230701494845] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lin CH, Chen YS, Lin CH, Lin KS. Factors affecting time to rehospitalization for patients with major depressive disorder. Psychiatry Clin Neurosci 2007; 61:249-54. [PMID: 17472592 DOI: 10.1111/j.1440-1819.2007.01662.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Major depressive disorder is a common psychiatric condition. Hospitalization is usually indicated for patients with more severe symptoms and severe functional impairment. Rehospitalization is known as the re-emergence of significant depressive symptoms. The purpose of the present study was to investigate the risk factors affecting time to rehospitalization. Rehospitalization status was monitored for all patients with major depressive disorder discharged from Kai-Suan Psychiatric Hospital between 1 January 2002 and 31 December 2003. Patients were followed up with respect to rehospitalization until 31 December 2004. The Kaplan-Meier method was used to calculate the median time to rehospitalization. Risk factors associated with rehospitalization were examined on Cox proportional hazards regression. Three hundred patients were recruited. Median time to readmission was 174 days (SD = 37). Comorbid alcohol abuse/dependence (hazard ratio [HR] = 1.841, 95% confidence interval [CI] = 1.229-2.758, P < 0.01), comorbid personality disorders (HR = 1.530, 95%CI = 1.053-2.223, P < 0.05), and the number of previous hospitalizations (HR = 1.121, 95%CI = 1.056-1.190, P < 0.001) were found to be predictors of the shorter time to rehospitalization over the 360-day study. Further research should be carried out to test risk factors in a prospective study, and to study the cost-effectiveness of interventions to reduce risk factors and rehospitalizations.
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Abstract
OBJECTIVE The aim of this study is to identify factors associated with readmission to adolescent psychiatric inpatient care, in the context of a relapsing major mental illness. METHOD Data were obtained from 71 patients admitted to an adolescent psychiatric inpatient unit over a 2-year period. Patients who were rehospitalized within 12 months of discharge were compared with patients who had only one admission during the study period with respect to diagnosis, age of first admission, history of child sexual abuse (CSA) and the events precipitating admission. RESULTS Medication non-adherence and a history of CSA were positively and independently associated with relapse readmission, while a trend emerged among readmitted patients toward younger age at first psychiatric hospitalization. A negative association was found between readmission and the experience of personal loss. Readmission was not related to DSM-IV axis I or axis II diagnosis, including substance abuse. CONCLUSIONS The association, in an adolescent sample, of medication non-adherence and relapse readmission is consistent with findings from numerous adult studies, as is the trend toward younger age of first admission. The relationship of a history of CSA to readmission has attracted little previous research and the finding of a positive association suggests that further investigation of a history of CSA in this context is warranted. The implications of these findings and suggestions for further research are discussed.
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Affiliation(s)
- Candace Bobier
- Youth Inpatient Unit, The Princess Margaret Hospital, P.O. Box 800, Christchurch, New Zealand.
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Hendryx MS, Russo JE, Stegner B, Dyck DG, Ries RK, Roy-Byrne P. Predicting rehospitalization and outpatient services from administration and clinical databases. J Behav Health Serv Res 2003; 30:342-51. [PMID: 12875101 DOI: 10.1007/bf02287322] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The study tests whether psychiatric services utilization may be predicted from administrative databases without clinical variables equally as well as from databases with clinical variables. Persons with a psychiatric hospitalization at an urban medical center were followed for 1 year postdischarge (N = 1384.) Dependent variables included statewide rehospitalization and the number of hours of outpatient services received. Three linear and logistic regression models were developed and cross-validated: a basic model with limited administrative independent variables, an intermediate model with diagnostic and limited clinical indicators, and a full model containing additional clinical predictors. For rehospitalization, the clinical cross-validated model accounted for twice the variance accounted by the basic model (adjusted R2 = .13 and .06, respectively). For outpatient hours, the basic cross-validated model performed as well as the clinical model (adjusted R2 = .36 and .34, respectively). Clinical indicators such as assessment of functioning and co-occurring substance use disorder should be considered for inclusion in predicting rehospitalization.
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Affiliation(s)
- Michael S Hendryx
- Washington Institute for Mental Illness Research and Training, Washington State University, 310 N. Riverpoint Blvd., P. O. Box 1495, Spokane, WA 99210, USA.
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Predicting Rehospitalization and Outpatient Services From Administration and Clinical Databases. J Behav Health Serv Res 2003. [DOI: 10.1097/00075484-200307000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND The diagnostic category of adjustment disorders continues to receive little attention in the research literature despite its estimated incidence of 5-21% in psychiatric consultation services for adults and 7.1% in inpatient admissions. METHODS Ten years of readmission data were reviewed for six diagnostic categories: adjustment disorders, major depressive disorder (single episode and recurrent), dysthymia, any anxiety disorder and depression NOS. Cox regression analysis was used. RESULTS Admission diagnosis was a significant predictor of readmission, with adjustment disorders resulting in significantly fewer readmissions than the group as a whole, and major depression recurrent resulting in significantly more readmissions. LIMITATIONS Structured interviews were not used for the establishment of admission diagnoses. CONCLUSIONS Readmission rates in this sample support the construct validity of the adjustment disorders category. The category includes a significant minority of patients admitted to psychiatric hospitalization.
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Affiliation(s)
- Rick Jones
- Laureate Research Center, 6655 South Yale Avenue, Tulsa, OK 74136, USA
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Abstract
The purpose of this study was to characterize the clinical and psychosocial factors of residents living in psychiatric nursing homes, assess residents' levels of mental health service utilization, and examine the factors that predict the utilization of mental health services. Data were collected from 200 randomly selected residents with schizophrenia living in four intermediate care facilities. Fewer than 60% of residents received mental health services beyond medication and nearly one-half of the residents were readmitted to the hospital in the course of a year. Family contact and involvement in activities were associated with mental health service utilization. Hospital readmission was predicted, not by substance use, but rather by not using substances. There is a growing need among service providers to better identify relevant factors that are important in treatment planning and service delivery. Attention to these issues may impact treatment provision and outcomes for persons with schizophrenia and their families.
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Affiliation(s)
- R L Anderson
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City 52242, USA.
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Averill PM, Hopko DR, Small DR, Greenlee HB, Varner RV. The role of psychometric data in predicting inpatient mental health service utilization. Psychiatr Q 2001; 72:215-35. [PMID: 11467156 DOI: 10.1023/a:1010396831037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Inpatient mental health readmission rates have increased dramatically in recent years, with a subset of consumers referred to as revolving-door patients. In an effort to reduce the financial burden associated with these patients and increase treatment efficacy, researchers have begun to explore factors associated with increased service utilization. To date, predictors of increased service usage are remarkably discrepant across studies. Further exploration, therefore, is needed to better explicate the relevance of "traditional" predictors and also to identify alternate strategies that may assist in predicting rehospitalization. One method that may be helpful in identifying patients at high risk is the development of a psychometric screening procedure. As a means to this end, the present study was designed to assess the potential usefulness of psychometric data in predicting mental health service utilization. The sample consisted of 131 patients hospitalized during an index period of 8 months at an acute-care psychiatric hospital. Number of readmissions was recorded in a 9 month post-index period. Measures completed during the index admission included the Brief Psychiatric Rating Scale-Anchored (BPRS-A), Symptom Checklist-90-Revised (SCL-90-R), Kaufman Brief Intelligence Test (K-BIT), and the Beck Depression Inventory (BDI). Results indicated that psychometric data accounted for significant variance in predicting past, present and future mental health service utilization. The BPRS-A, SCL-90-R, and BDI show particular promise as time efficient psychometric screening instruments that may better enable practitioners to identify patients proactively who are at increased risk for rehospitalization. Implications are discussed with regard to patient-treatment matching and discharge planning.
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Affiliation(s)
- P M Averill
- University of Texas-Houston Medical School and the Harris County Psychiatric Center, Houston, TX 77021, USA
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