Predicting 30-Day Readmissions: Evidence From a Small Rural Psychiatric Hospital

Abstract

To improve quality of care and patient outcomes, and to reduce costs, hospitals in the United States are trying to mitigate readmissions that are potentially avoidable. By identifying high-risk patients, hospitals may be able to proactively adapt treatment and discharge planning to reduce the likelihood of readmission. Our objective in this study was to derive and validate a predictive model of 30-day readmissions for a small rural psychiatric hospital in the northeast. However, this model can be adapted by other rural psychiatric hospitals-a context that has been understudied in the literature. Our sample consisted of 1912 adult inpatients (1281 in the derivation cohort and 631 in the validation cohort), who were admitted between August 1, 2014, and July 31, 2016. We used deidentified data from the hospital's electronic medical record, including physician orders and discharge summaries. These data were merged with community-level variables that reflected the availability of care in the patients' zip codes. We first considered the correlates of 30-day readmission in a regression framework. We found that the probability of readmission increased with the number of previous admissions (vs. no readmissions). Moreover, the probability of readmission was much higher for patients with a depressive disorder (vs. no depressive disorder), with another mood disorder (vs. no other mood disorder), and/or with a psychotic disorder (vs. no psychotic disorder). We used these associations to derive a predictive model, in which we used the regression coefficients to construct a score for each patient. We then estimated the predicted probability of 30-day readmission on the basis of that score. After validating the model, we discuss the implications for clinical practice and the limitations of our approach.

Prediction of risks and odds of rehospitalization of patients with eating disorders in anxiety-depressive disorders

“…The likelihood of readmission depending on the number of previous hospitalizations was investigated among 519 patients in eight New York City hospitals and readmission within 30 days of discharge among 1912 patients in a rural psychiatric hospital in the United States. These studies demonstrated a higher likelihood of readmission with an increase in the number of previous hospitalizations, which is consistent with the results of our study, where the presence of previous hospitalizations increased the risks and odds of readmission, and the number of previous hospitalizations increased the odds of readmission [17,18].…”