Patient Characteristics Associated with Inpatient Psychiatric Re-admissions and the Utility of the READMIT Clinical Risk Index

Abstract

In response to the problem of frequent 30-day readmissions to inpatient psychiatric facilities, Vigod and colleagues (2015) developed the READMIT clinical risk index to identify risk factors for psychiatric inpatient readmissions. The purpose of this descriptive retrospective study was to examine the effectiveness of the READMIT clinical risk index to identify patients that are at high risk for a 30-day inpatient psychiatric readmission at a state psychiatric hospital in the southeastern US. Data were extracted from the discharge summaries of patients discharged between September 2013 and December 2014. Data collected included patient demographic variables (age, gender, race/ethnicity, primary diagnosis, housing status at discharge, employment, long-acting injectable at discharge, substance abuse, education, and insurance status) and study variables from the READMIT clinical risk index (repeat admission, emergent admission, age, diagnosis and discharge, medical comorbidity, intensity, and time in hospital). The inclusion criterion was age 18 and above. There were no exclusion criteria. Findings indicated that age, insurance status, previous lifetime admissions, 'diagnoses and discharge' scores, and higher READMIT clinical risk index scores were associated with 30-day readmissions. Future research should include a prospective study of the READMIT clinical risk index to assess its predictability of 30-day readmissions and explore possible use of the minimum clinical risk index score to trigger evaluation of patient need for enhanced transitional care services posthospital discharge.

Clinical risk model to predict 28-day unplanned readmission via the accident and emergency department after discharge from acute psychiatric units for patients with psychotic spectrum disorders

“…35,47 However, other papers have found that depot medications had no association with the risk of readmission. 14,48 Depot medications are sometimes prescribed for patients with a high risk of poor drug adherence, which some have suggested to be the cause for relapse. However, some pieces of research have failed to find an association, suggesting that medication non-adherence is more likely to be associated with delayed readmissions to psychiatric units, rather than rapid readmissions such as the time frame of 28 days used in this study.…”

“…13 The model was then applied to a different group of patients in south-eastern USA with good predictive ability. 14 Risk models are already being deployed in some countries. Scotland has deployed a risk model to calculate the risk of readmissions for all diagnoses, including psychiatric hospital readmission.…”

Nursing Advocacy and Long Acting Injectables to Reduce High Readmission Rates: Quality Initiative

“…They concluded that recording medication compliance in the EMR is important for identifying atrisk patients. Electronic tracking was echoed by Roque, Findlay, Okoli, and El-Mallakh (2017), who also reported that patients with chronic mental health issues need clinical screening for risk of readmission to reduce 30-day readmission rates. Tiihonen et al (2017) studied the effectiveness of various antipsychotic formulations (i.e., LAIs vs. oral medications).…”

Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study

“…Known as a dual diagnosis, an estimated one third to one half of adults diagnosed with a mental illness also have a substance use disorder (Antai-Otong, Theis, & Patrick, 2016;Drake, Mueser, & Brunette, 2007; European Monitoring Centre for Drugs and Drug Addiction [EMCDDA], 2015; Petrakis, Robinson, Myers, Kroes, & O'Connor, 2018). Also referred to as having a concurrent disorder or a co-occurring disorder (EMCDDA, 2015), individuals in this subgroup face many challenges including being more likely to have added health problems (Drake et al, 2006;Rosenberg, Drake, Brunette, Wolford, & Marsh, 2005) as well as being at increased risk for adverse outcomes, including treatment nonadherence and suicide (Beeber & Stein, 2015;Cosci & Fava, 2011;Czobor et al, 2015;Drake, O'Neal, & Wallach, 2008;Greenberg & Rosenheck, 2014;Jacobs et al, 2010;Krausz et al, 2013;Montes, Maurino, de Dios, & Medina, 2013;Roque, Findlay, Okoli, & El-Mallakh, 2017;Sendt, Tracy, & Bhattacharyya, 2015). The frequency of emergency room visits as well as hospital readmission rates and length of stay are significantly higher for patients with a dual diagnosis than for those with either a mental illness or a substance use disorder alone (Antai-Otong et al, 2016;Cosci & Fava, 2011;Drake et al, 2008;Jacobs et al, 2010).…”