Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis

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 30day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.

Predictors of Intensive Treatment in Patients With Obsessive-Compulsive Disorder

“…It appeared that patients with OCD who were single, who had more severe comorbid depressive symptoms, who used psychotropic medication, and who had a low quality of life were significantly more likely to have intensive treatment 2 years later. Our results on being single and more severe comorbid depression resemble the results concerning other mental disorders (18,19,21). Thus, also in patients with OCD, these variables predict future intensive treatment.…”

“…A systematic review of 58 papers on predictors of readmission in patients with several mental disorders indicates that previous hospitalization, younger age, being unmarried, having lower financial means, not being satisfied with the index treatment, having more hospital days on the index admission, and a negative attitude toward medication were predicting factors for psychiatric readmission (18). In addition, being male, having psychotic symptoms, a longer duration of untreated psychosis, less social satisfaction, disturbed family dynamics, residing in an urban area, and illegal drugs misuse were found predictive of hospitalization in recent prospective cohort studies involving several mental disorders (18)(19)(20)(21)(22). A population study combined several survey and register databases of 2,638 individuals born in 1953, including interviews with their mothers.…”

Electroconvulsive therapy is associated with lower readmission rates in patients with schizophrenia

“…The effective treatment of patients with schizophrenia can be difficult with high readmission rates. Previous studies found that 70.5% patients with schizophrenia were readmitted within 10 years, and 25% were readmitted within 4 months of the first hospitalization [4,5] . Readmissions are often disruptive to patients and their families and place a strain on limited healthcare resources.…”

“…Previous studies have identified several factors associated with psychiatric readmissions, including sociodemographic factors, clinical factors (e.g. diagnosis, severity, symptom profile, medical comorbidities, treatments, inpatient length of stay), and post-discharge factors (e.g., medication adherence, family and social support, use of community healthcare services) [5,6] .…”

“…The present study used inpatient data from one large psychiatric hospital in Beijing to examine whether ECT used in the index course is associated with 3-month or 6-month J o u r n a l P r e -p r o o f psychiatric inpatient readmissions. Based on previous findings [5,7,13] , we hypothesized that, compared with psychiatric inpatients who did not receive ECT, those who received ECT treatment would have a lower probability of readmission within 3 and 6 months after their index hospitalization. We also examined the association of ECT on readmissions by patient's age, sex, and other clinical characteristics including medications.…”