Effectiveness of a Brief Care Management Intervention for Reducing Psychiatric Hospitalization Readmissions

Abstract

This study examines a recovery-focused care management bridging strategy implemented during time of inpatient stay with the goal to increase engagement in aftercare and reduce early psychiatric readmissions. The sample included 195 individuals who received care from a large psychiatric specialty hospital. Eighty-seven individuals were assigned to receive the intervention, while 108 individuals were assigned to the control group. Individuals in the intervention group received a brief interview prior to inpatient discharge plus usual care, and individuals in the control group received usual care. After controlling for age, living situation, and utilization, individuals in the control group were more likely to be readmitted within 30 days of an index readmission than individuals in the intervention group (OR = 2.44, p = .02). Bridging strategies utilized prior to discharge for individuals at higher risk of early mental health inpatient readmission may be used as an effective alternative to more costly interventions.

Evaluation of the transitional discharge model on use of psychiatric health services: An interrupted time series analysis

“…A study evaluating the transitional care service (TCS) in male patients from an acute psychiatric unit in South Africa, which involved follow‐up phone calls, home visits, reminders for follow‐up, encouragement to adhere to treatment plan and psychoeducation, did not find a significant difference in number of readmissions (Botha, Coetzee, Koen, & Niehaus, ). Brief Care Management, which integrates a predischarge interview regarding goals and barriers to treatment in addition to usual care, had demonstrated reduced readmission rates in individuals with a high risk of readmission, when compared to those who received usual care only in a psychiatric specialty hospital in the United States (Taylor et al., ). The critical time intervention (CTI) and the brief critical time intervention (BCTI) involve support from a CTI worker during a limited transition period from hospital to community living with decreasing support over time to encourage the development of long‐term support from services, family and friends.…”

Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

“…When considering the reduction of readmission, the most successful interventions aim to bridge the epistemic, professional and physical boundaries between hospital and community [14,29,63], either locating community staff on the ward, or ward staff in the community, increasing continuity of care or increasing knowledge of service users and families (see also [72]). [71]).…”

“…Whilst some studies found evidence for a reduction in readmission due to the interventions [26,28,40], many failed to evidence this effect [6,33,36]. The studies that had an effect on readmission tended to focus on either education, therapeutic relationships or increased continuity of care [28,63,64]. Many of the successful interventions bridged the boundaries between ward and community by providing care from ward based professionals in the community [28,54] or having community teams leading discharge planning on the wards [40].…”

“…For example integrated care pathways are evidenced to facilitate early discharge [53], as is introducing a community link team [41]. Whereas interventions that focus on a single element of the care pathway, or a single person seem less successful in solving this problem, for example the introduction of a team to co-ordinate discharge planning had little effect on length of stay [63,68]. Similarly, introducing a single professional to address this challenge [59] or relying on the education of the service user [47], also proved unsuccessful.…”

“…All of which could be categorised as either staff level, service level, or service-user level and many sit within multiple categories. From a service level perspective, barriers were related to insufficient funding of services or interventions, ineffective information sharing and the effect of the physical location of services, particularly for rural community services [10,12,26,63]. Effective planning was also a reported facilitator [68].…”