Psychiatric readmission rates in a multi-level mental health care system – a descriptive population cohort study

Abstract

Background Readmission rates are frequently used as a quality indicator for health care, yet their validity for evaluating quality is unclear. Published research on variables affecting readmission to psychiatric hospitals have been inconsistent. The Norwegian specialist mental health care system is characterized by a multi-level structure; hospitals providing specialized -largely unplanned care and district psychiatric centers (DPCs) providing generalized -more often planned care. In certain service systems, readmission may be an integral part of individual patients’ treatment plan. The aim of the present study was to describe and examine the task division in a multi-level health care system. This we did through describing differences in patient population (age, sex, diagnosis, substance abuse comorbidity and length of stay) and admissions types (unplanned vs. planned) treated at different levels (hospital, DPC or both), and by examining whether readmission risk differ according to type and place of treatment of index-admission and travel-time to nearest hospital and DPC. Methods In this population-based cohort study using administrative data we included all individuals aged 18 and older who were discharged from psychiatric inpatient care with an ICD-10 diagnosis F2-F6 (“functional mental disorders”) in 2012. Selecting each individual’s first discharge during 2012 as index gave N = 16,185 for analyses following exclusions. Analysis of readmission risk were done using Kaplan-Maier failure curves. Results Overall, 15.1 and 47.7% of patients were readmitted within 30 and 365 days, respectively. Unplanned admission patients were more likely to be readmitted within 30 days than planned patients. Those transferred between hospital and DPC during index admission were more likely to be readmitted within 365 days, and to experience planned readmission. Patients with short travel time were more likely to have unplanned readmission, while patients with long travel time were more likely to have planned readmission. Conclusions DPCs and hospitals fill different purposes in the Norwegian health care system, which is reflected in different patient populations. Differences in short term readmission rates between hospitals and DPCs disappeared when type of admission (unplanned/planned) was considered. The results stress the importance of addressing differences in organisation and task distribution when comparing readmission rates between mental health systems.

Predictors of Length of Hospitalization and Impact on Early Readmission for Mental Disorders

“…There are evidence that long-stay hospitalizations (≥31 days) increase the risk of complications or adverse outcomes, especially for patients with chronic physical illnesses [ 28 , 29 ]. Early readmission within 30-days after hospital discharge is a standard indicator of adverse outcome, pointing to inadequate discharge planning or post-discharge follow-up in the community [ 8 , 9 ].…”

“…Both long-stay [ 3 ] and brief-stay hospitalizations [ 4 , 5 ] have been associated with early readmission (within 30 days of discharge) [ 6 ], limiting recommendations related to best practices. Rates of early readmission following hospital discharge, identified in psychiatry as a key adverse outcome [ 7 , 8 , 9 ], are elevated. Previous studies reported that 8–17% of patients with MD were readmitted early following hospital discharge [ 10 , 11 , 12 ].…”