Does the Hospital Predict Readmission? A Multi-level Survival Analysis Approach

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).

Psychiatric Readmission of Children and Adolescents: A Systematic Review and Meta-Analysis

“…In total, 17 studies provided a separate ES for the relationship between participant age and readmission (4,5,14,15,(17)(18)(19)(20)(21)(22)(23)(24)(40)(41)(42)(43). An ES for the relationship between gender and readmission was reported in 19 studies (3-6, 15, 17-24, 27, 40, 42-45), and ten studies provided an ES for race-ethnicity and readmission (5,15,17,18,21,23,27,43,46,47). When ESs were pooled, no significant differences in readmission by age, gender, or race-ethnicity were observed (see figure in online supplement).…”

“…Depressive disorders (N=6) (4,6,14,40,44,51), anxiety disorders (N=8) (4,6,22,24,40,42,45,51), internalizing disorders (N=4) (20,43,46,50), oppositional defiant disorder (N=4) (14,24,27,51), conduct disorder (N=3) (14,24,27), unspecified externalizing disorders (N=7) (20, 40, 42-44, 46, 50), posttraumatic stress disorder (N=5) (4,6,14,24,51), and the presence of a formal psychiatric diagnosis (N=5) (14,18,23,42,45) were not significantly associated with risk of readmission (see figure in online supplement).…”

Reducing pediatric psychiatric hospital readmissions and improving quality care through an innovative Readmission Risk Predictor Tool

“…The second most frequent readmission diagnosis noted in this study was Attention Deficit Hyperactivity Disorder (ADHD). A recent study in Illinois concluded similar findings that individual externalizing behaviors (impulsivity, oppositional behaviors, conduct disturbance, anger control, as well as school and peer functioning) were predictive of earlier readmission to the hospital (Leon, Stoner, & Dickson, ). This is in line with both the DMDD and ADHD diagnoses previously noted.…”

“…Externalizing behaviors resulted in restraint use and 1:1 staff necessity. In fact, one study confirmed that lower individual externalizing behaviors (reduction in acuity) resulted in reduced readmissions (Leon et al., ).…”

Predictors of behavioral health unit readmission within 30 days of discharge: A retrospective study

“…In another example, Leon et al. (2015) [ 20 ] detected no association between hospital characteristics and readmission, while Phillips et al. (2020) [ 21 ] documented the negative impact of low numbers of total beds and Medicaid discharges.…”