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Cheng P, Wang L, Zhao G, Li W. Dynamic risk factors of psychiatric readmission for major depressive disorder: A longitudinal study on patients treated with mono-antidepressant. Psychiatry Res 2024; 333:115750. [PMID: 38277810 DOI: 10.1016/j.psychres.2024.115750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
In this comprehensive study, we sought to unravel the risk factors for recurrence in Major Depressive Disorder (MDD), uniquely focusing on patients undergoing mono-antidepressant treatment. By considering psychiatric readmission as a direct indicator of MDD recurrence, we meticulously analyzed the records of 1,456 inpatients from a Chinese mental health center from 2012 to 2020. Our follow-up periods, spanning 90, 180, and 365 days post-discharge, allowed for a nuanced understanding of the recurrence dynamics. We identified four critical risk factors: thyroid function (FT3 and TSH), high-density lipoprotein (HDL) levels, and region of residence. Notably, the study revealed an increasing risk of readmission associated with decreased FT3 and HDL over time, while elevated TSH and residing in another province 's impact diminished. The antidepressant type did not significantly alter readmission risks, providing a unique perspective on MDD management. This research contributes to the field by offering a deeper understanding of how demographic and biochemical factors influence the likelihood of MDD recurrence, guiding more effective treatment approaches.
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Affiliation(s)
- Peng Cheng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Lirong Wang
- The Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Guangju Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Weihui Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
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Turner BJ, Robillard CL, Gretton A, Eslami A. Rapid psychiatric readmission in youth: A five-year retrospective Cohort Study. Psychiatry Res 2023; 325:115228. [PMID: 37178503 DOI: 10.1016/j.psychres.2023.115228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
This study describes predictors of psychiatric readmission among youth, including rapid readmission within 30 days of discharge. A retrospective chart review identified demographic features, diagnoses, and reasons for initial admission among 1324 youth admitted to the child and adolescent psychiatric emergency unit at a Canadian children's hospital. 22% of youth had at least one readmission and 8.8% had at least one rapid readmission during the five-year period. Personality disorder (HR=1.64, 95% CI=1.07, 2.52) and self-harm concerns (HR=0.65, 95% CI=0.48, 0.89) predicted odds of readmission Reducing readmission is an important goal, particularly for youth with personality concerns.
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Affiliation(s)
| | | | | | - Ali Eslami
- BC Children's Hospital, Canada; University of British Columbia, Canada
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Tan XW, Chan CYW, Lum AWM, Lee ES, Mok YM, Fung DSS, Tor PC. Association of cardiovascular metabolic risk factor measurements with psychiatric readmission among in-hospital patients with severe mental illness: a retrospective study. BMC Psychiatry 2022; 22:43. [PMID: 35042498 PMCID: PMC8767705 DOI: 10.1186/s12888-022-03704-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) and comorbid physical conditions were often associated with higher risks of mortality and hospital readmission. In this study, we aim to examine the association of cardiovascular metabolic risk factor measurements with risks of psychiatric readmissions among in-hospital patients with severe mental illness (SMI). METHODS We collected the longitudinal information of laboratory investigations, blood pressure and body mass index (BMI) among in-hospital patients who had been diagnosed with schizophrenia, major depression disorder or bipolar disorder and with comorbid diagnosis of hypertension, hyperlipidemia or diabetes from Jan 2014 to Jan 2019. The primary outcome was time to first psychiatric readmission. Cox proportional hazard model was utilized to calculate the hazard risks (HR) of cardiovascular metabolic risk factors with psychiatric readmission. RESULTS A total of 5,256 patients were included in the analysis. Compared to patients with normal blood parameters, patients with aberrant tests of high-density dyslipidemia (HDL) and diastolic blood pressure (DBP) during in-hospitalization period were associated with higher risks to first psychiatric readmission [ HR (Hazard Ratio), 1.37 95% Confidence interval (CI), 1.03-1.83 for HDL and HR, 1.32 (95% CI, 1.04-1.67])for DBP]. Compared to patients with optimal monitoring, patients with suboptimal monitoring of blood lipids and blood pressure during in-hospitalization period or recommended window period of cardiovascular disease (CVD) risk management were associated with higher risks to first psychiatric readmission. CONCLUSIONS Aberrant cardiovascular metabolic blood test and blood pressure and missing measurements among in-hospital patients with SMI were associated with increased risks of psychiatric readmissions. This calls for more active screening and monitoring of CVD risk factors for those in-hospital patients in need.
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Christopher Yi Wen Chan
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Alvin Wai Mum Lum
- grid.414752.10000 0004 0469 9592Medical Care Service, Institute of Mental Health, Singapore, 539747 Singapore
| | - Eng Sing Lee
- grid.466910.c0000 0004 0451 6215Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, 138543 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Yee Ming Mok
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
| | - Daniel Shuen Sheng Fung
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Phern Chern Tor
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
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Han X, Jiang F, Needleman J, Guo M, Chen Y, Zhou H, Liu Y, Yao C, Tang Y. A sequence analysis of hospitalization patterns and service utilization in patients with major psychiatric disorders in China. BMC Psychiatry 2021; 21:245. [PMID: 33975564 PMCID: PMC8111895 DOI: 10.1186/s12888-021-03251-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/29/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Understanding the long-term inpatient service cost and utilization of psychiatric patients may provide insight into service demand for these patients and guide the design of targeted mental health programs. This study assesses 3-year hospitalization patterns and quantifies service utilization intensity of psychiatric patients in Beijing, China. METHODS We identified patients admitted for one of three major psychiatric disorders (schizophrenia, bipolar and depressive disorders) between January 1 and December 31, 2013 in Beijing, China. Inpatient admissions during the following 3 years were extracted and analyzed using sequence analysis. Clinical characteristics, psychiatric and non-psychiatric service use of included patients were analyzed. RESULTS The study included 3443 patients (7657 hospitalizations). The patient hospitalization sequences were grouped into 4 clusters: short stay (N = 2741 (79.61% of patients), who had 126,911 or 26.82% of the hospital days within the sample), repeated long stay (N = 404 (11.73%), 76,915 (16.26%) days), long-term stay (N = 101 (2.93%), 59,909 (12.66%) days) and permanent stay (N = 197 (5.72%), 209,402 (44.26%) days). Length and frequency of hospitalization, as well as readmission rates were significantly different across the 4 clusters. Over the 3-year period, hospitalization days per year decreased for patients in the short stay and repeated long stay clusters. Patients with schizophrenia (1705 (49.52%)) had 78.4% of cumulative psychiatric stays, with 11.14% of them in the permanent stay cluster. Among patients with depression, 23.11% had non-psychiatric hospitalizations, and on average 46.65% of their total inpatient expenses were for non-psychiatric care, the highest among three diagnostic groups. CONCLUSION Hospitalization patterns varied significantly among psychiatric patients and across diagnostic categories. The high psychiatric care service use of the long-term and permanent stay patients underlines the need for evidence-based interventions to reduce cost and improve care quality.
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Affiliation(s)
- Xueyan Han
- Peking University First Hospital, 8 Xishiku Road, Xicheng District, Beijing, China.
| | - Feng Jiang
- grid.16821.3c0000 0004 0368 8293Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, 1954 Huashan Road, Xuhui District, Shanghai, China
| | - Jack Needleman
- grid.19006.3e0000 0000 9632 6718Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS Box, Los Angeles, CA 951772 USA
| | - Moning Guo
- Beijing Municipal Health Commission Information Centre, 277 Zhao Deng Yu Road, Xicheng District, Beijing, China
| | - Yin Chen
- grid.449412.ePeking University International Hospital, 29 Sheng Ming Yuan Road, Haidian District, Beijing, China
| | - Huixuan Zhou
- grid.411614.70000 0001 2223 5394School of Sport Science, Beijing Sport University, 48 Xinxi Road, Haidian Street, Beijing, China
| | - Yuanli Liu
- grid.506261.60000 0001 0706 7839School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China
| | - Chen Yao
- grid.411472.50000 0004 1764 1621Peking University First Hospital, 8 Xishiku Road, Xicheng District, Beijing, China ,grid.11135.370000 0001 2256 9319Peking University Clinical Research Institute, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Yilang Tang
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite 300, Atlanta, GA, USA; Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA USA ,grid.414026.50000 0004 0419 4084Atlanta VA Medical Center, Decatur, GA USA
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Madden A, Vajda J, Llamocca EN, Campo JV, Gorham TJ, Lin S, Fontanella CA. Factors associated with psychiatric readmission of children and adolescents in the U.S.: A systematic review of the literature. Gen Hosp Psychiatry 2020; 65:33-42. [PMID: 32450472 DOI: 10.1016/j.genhosppsych.2020.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE A systematic review of research assessing factors associated with inpatient psychiatric readmission of children and adolescents. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we searched 8 databases (1994-2018) to identify relevant articles on factors associated with youth psychiatric readmission. Selected articles addressed one or more factors associated with psychiatric readmission for children and adolescents (≤21 years of age) admitted to a psychiatric hospital in the United States for a primary mental health diagnosis. Two authors independently reviewed article abstracts, titles, and text. RESULTS Of 7903 retrieved articles, 30 studies met inclusion criteria. Analyzed variables were categorized according to child demographic and clinical characteristics; family, provider, and community characteristics; and treatment and aftercare characteristics. Available studies were markedly heterogeneous in methodology and outcomes. Factors associated with an increased risk of readmission included greater symptom severity, clinical diagnoses such as psychosis and affective disorders, suicidal behavior and self-injury, poor family functioning, and longer lengths of index hospital stay. CONCLUSIONS Controlled trials of interventions to improve care and reduce recidivism for psychiatrically hospitalized youth are needed. Future research will benefit from a guiding theoretical framework, more representative samples, and standardized exposure/outcome measures.
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Affiliation(s)
- Abaigael Madden
- The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, United States.
| | - Jordan Vajda
- The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, United States; Division of Epidemiology, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210, United States.
| | - Elyse N Llamocca
- Division of Epidemiology, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210, United States; Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Columbus, OH 43210, United States.
| | - John V Campo
- West Virginia University Rockefeller Neuroscience Institute, 8 Medical Center Drive, Morgantown, WV 26505, United States.
| | - Tyler J Gorham
- Abigail Wexner Research Institute, Nationwide Children's Hospital, 431 South 18th Street, Columbus, OH 43205, United States.
| | - Simon Lin
- The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, United States; Abigail Wexner Research Institute, Nationwide Children's Hospital, 431 South 18th Street, Columbus, OH 43205, United States.
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Columbus, OH 43210, United States.
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Han X, Jiang F, Tang Y, Needleman J, Guo M, Chen Y, Zhou H, Liu Y. Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis. BMC Psychiatry 2020; 20:113. [PMID: 32160906 PMCID: PMC7065326 DOI: 10.1186/s12888-020-02515-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China. METHODS Data on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics. RESULTS The 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04-1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56-0.91) and frequent readmissions (OR 0.60, 95%CI 0.40-0.91). CONCLUSION More than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.
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Affiliation(s)
- Xueyan Han
- grid.413106.10000 0000 9889 6335School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China
| | - Feng Jiang
- grid.413106.10000 0000 9889 6335School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China
| | - Yilang Tang
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite, Atlanta, GA 300 USA ,grid.414026.50000 0004 0419 4084Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA USA
| | - Jack Needleman
- grid.19006.3e0000 0000 9632 6718Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS Box, Los Angeles, CA 951772 USA
| | - Moning Guo
- Beijing Municipal Health Commission Information Centre, No. 277 Zhao Deng Yu Lu, Xicheng District, Beijing, China
| | - Yin Chen
- grid.449412.ePeking University International Hospital, No. 29 Sheng Ming Yuan Lu, Haidian District, Beijing, China
| | - Huixuan Zhou
- grid.413106.10000 0000 9889 6335School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China ,grid.411614.70000 0001 2223 5394School of Sport Science, Beijing Sport University, No. 48 Xin Xi Lu, Haidian District, Beijing, China
| | - Yuanli Liu
- School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China.
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Barker LC, Gruneir A, Fung K, Herrmann N, Kurdyak P, Lin E, Rochon PA, Seitz D, Taylor VH, Vigod SN. Predicting psychiatric readmission: sex-specific models to predict 30-day readmission following acute psychiatric hospitalization. Soc Psychiatry Psychiatr Epidemiol 2018; 53:139-149. [PMID: 29124290 DOI: 10.1007/s00127-017-1450-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 10/22/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. METHODS We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among women (n = 33,353) and men (n = 32,436) discharged from all psychiatric units in Ontario, Canada (2008-2011). Predictor variables included sociodemographics, health service utilization, and clinical characteristics. Using derivation data sets, multivariable logistic regression models were fit to determine optimal predictive models for each sex separately. Results were presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). The multivariable models were then applied in the internal validation data sets. RESULTS The 30-day readmission rates were 9.3% (women) and 9.1% (men). Many predictors were consistent between women and men. For women only, personality disorder (aOR 1.21, 95% CI 1.03-1.42) and positive symptom score (aOR 1.41, 95% CI 1.09-1.82 for score of 1 vs. 0; aOR 1.44, 95% CI 1.26-1.64 for ≥ 2 vs. 0) increased odds of readmission. For men only, self-care problems at admission (aOR 1.20, 95% CI 1.06-1.36) and discharge (aOR 1.44, 95% CI 1.26-1.64 for score of 1 vs. 0; aOR 1.79, 95% CI 1.17-2.74 for 2 vs. 0), and mild anxiety rating (score of 1 vs. 0: aOR 1.30, 95% CI 1.02-1.64, derivation model only) increased odds of readmission. Models had moderate discriminative ability in derivation and internal validation samples for both sexes (c-statistics 0.64-0.65). CONCLUSIONS Certain key predictors of psychiatric readmission differ by sex. This knowledge may help to reduce psychiatric hospital readmission rates by focusing interventions.
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Affiliation(s)
| | - Andrea Gruneir
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Women's College Hospital and Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Women's College Hospital and Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Elizabeth Lin
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Paula A Rochon
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Women's College Hospital and Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Dallas Seitz
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Women's College Hospital and Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Women's College Hospital and Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
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Rieke K, McGeary C, Schmid KK, Watanabe-Galloway S. Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences? Community Ment Health J 2016; 52:675-82. [PMID: 26303903 DOI: 10.1007/s10597-015-9921-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/10/2015] [Indexed: 12/13/2022]
Abstract
The objectives of the study were to compare characteristics of women and men discharged from an inpatient psychiatric facility and to identify gender-specific risk factors associated with 30-day and 1-year readmission using administrative data. The sample included adults discharged from an inpatient psychiatric facility in a Midwestern city (N = 1853). The analysis showed that the 30-day readmission rate was significantly lower among women, but there was no difference in the 1-year readmission rate. Risk factors for readmission differed by gender. For example, for 30-day readmission, being on Medicare versus commercial insurance increased the odds for women (OR 3.08; 95 % CI 1.35-7.04) and taking first-generation antipsychotics versus no antipsychotics increased the odds for men (OR 2.09; 95 % CI 1.26-3.48). These findings suggest there are important differences between women and men readmitted to an inpatient psychiatric facility. Future strategies need to take into account gender-specific risk factors in order to improve long-term patient outcomes.
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Affiliation(s)
- Katherine Rieke
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | | | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
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Barros REM, Marques JMDA, Santos JLF, Zuardi AW, Del-Ben CM. Impact of length of stay for first psychiatric admissions on the ratio of readmissions in subsequent years in a large Brazilian catchment area. Soc Psychiatry Psychiatr Epidemiol 2016; 51:575-87. [PMID: 26801498 DOI: 10.1007/s00127-016-1175-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to verify the impact that the length of stay has on the rates of readmission for patients who were first admitted to various inpatient psychiatric units in a large catchment area in a middle-income country. METHODS The study included all patients who were first admitted to the 108 acute psychiatric beds available in the catchment area of Ribeirão Preto, Brazil, for a period of 8 years. Demographic features, inpatient unit of discharge, diagnosis and length of stay were assessed by bivariate analysis. An analysis of the time span between first admission and readmission was also conducted using survival curves estimated by the Kaplan-Meier formula. For the analyses of the risk of readmissions, a logistic regression analysis was conducted. RESULTS From a total of 6261 patients admitted in the period of the survey, approximately one-third (2006) had at least one other readmission during the follow-up period. The rates per year of early readmission (within 90 days after discharge) varied from 16.1 to 20.9 %. The risk of readmission was higher immediately after discharge. The survival analysis showed that ultrashort length of stay (1-2 days) was associated with reduced odds of readmission, but multivariate logistic analysis showed no association between length of stay and the odds of readmissions. The predictors of early readmission included the diagnosis of depressive, bipolar, psychotic, and non-alcohol-related disorders, younger ages and unemployment. CONCLUSIONS Duration of the first psychiatric admission was not associated with a higher risk of readmissions. Predictors for early readmissions of first-time-admitted psychiatric patients seem to be more related to the severity of the psychiatric diagnosis and demographic characteristics.
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Affiliation(s)
- Regis Eric Maia Barros
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto-USP, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, CEP: 14048-900, Brazil.
| | | | - Jair Lício Ferreira Santos
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Antonio Waldo Zuardi
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto-USP, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, CEP: 14048-900, Brazil
| | - Cristina Marta Del-Ben
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto-USP, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, CEP: 14048-900, Brazil
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Abstract
Time to psychiatric rehospitalization was predicted for a sample of 1473 Medicaid-insured youth in Illinois in 2005 and 2006. A multi-level model statistical strategy was employed to account for the fact that youth days to rehospitalization were nested within hospital and to test the hypothesis that hospitals would vary significantly in return rates, controlling for individual-level (e.g., symptom, demographic) variables. Hospitals did not vary significantly in days to rehospitalization. At the individual-level, level of externalizing behavior and residential treatment placement predicted a faster return to the hospital. These results support the perspective that hospital outcomes are best operationalized using variables tied more directly to the inpatient episode (e.g., LOS, reductions in acuity).
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Vigod SN, Kurdyak PA, Seitz D, Herrmann N, Fung K, Lin E, Perlman C, Taylor VH, Rochon PA, Gruneir A. READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units. J Psychiatr Res 2015; 61:205-13. [PMID: 25537450 DOI: 10.1016/j.jpsychires.2014.12.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/28/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022]
Abstract
Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.
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Affiliation(s)
- Simone N Vigod
- Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada.
| | - Paul A Kurdyak
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada
| | - Dallas Seitz
- Queens University, 99 University Avenue, Kingston, Ontario, Canada
| | - Nathan Herrmann
- University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Elizabeth Lin
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada
| | - Christopher Perlman
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada
| | - Valerie H Taylor
- Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada
| | - Paula A Rochon
- Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; University of Alberta, 6-40 University Terrace, Edmonton, Alberta, Canada
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