Risk Factors for Early Readmission to Acute Care for Persons With Schizophrenia Taking Antipsychotic Medications

Abstract

OBJECTIVE The study examined risk factors for readmission to acute care among Florida Medicaid enrollees with schizophrenia treated with antipsychotics. METHODS Medicaid and service use data for 2004 to 2008 were used to identify adults with schizophrenia discharged from hospitals and crisis units who were taking antipsychotics. Data were extracted on demographic characteristics, service use before admission, psychopharmacologic treatment after discharge, and readmission to acute behavioral health care. Cox proportional hazards regression estimated readmission risk in the 30 days after discharge and in the period after 30 days for participants not readmitted in the first 30 days. RESULTS The mean±SD age of the 3,563 participants was 43.4±11.1; 61% were male, and 38% were white. Participants had 6,633 inpatient episodes; duration of hospitalization was 10.6±7.0 days. Readmission occurred for 84% of episodes, 23% within 30 days. Variables associated with an increased readmission risk in the first 30 days were shorter hospitalization (hazard ratio [HR]=1.18, 95% confidence interval [CI]=1.10-1.27, p<.001), shorter time on medication before discharge (HR=1.19, CI=1.06-1.35, p=.003), greater prehospitalization use of acute care (HR=2.64, CI=2.29-3.05, p<.001), serious general medical comorbidity (HR=1.21, CI=1.06-1.38, p=.005), and prior substance abuse treatment (HR=1.58, CI=1.37-1.83, p<.001). After 30 days, hospitalization duration and time on medication were not significant risk factors. CONCLUSIONS Short hospital stays for persons with schizophrenia may be associated with risk of early readmission, possibly because the person is insufficiently stabilized. More chronic risk factors include prior acute care, general medical comorbidity, and substance abuse.

Internações e reinternações psiquiátricas em um hospital geral de Porto Alegre: características sociodemográficas, clínicas e do uso da Rede de Atenção Psicossocial

“…The mean age of the sample was 44.33 years, which is in agreement to other studies which presented mean higher than 37 years of age 7,11,16,20,21,24,33,34 . The findings of the present study did not show association between age and frequent readmissions, results corroborated by some studies in the area 24,33,34 .…”

“…This duration is even higher when compared to other studies evaluating this variable. Another study carried out in São Paulo 25 found a mean of 17.3 days and, in international ones, a mean duration between 10 and 20 days of hospitalization 6,7,11,16,21,34 . Finally, considering the variables of NPC follow-up, we highlight the data of 34.4% of participants in the study who did not follow-up before the investigated hospitalization, as well as over half the users in first hospitalization, which shows this ends up being the gateway for mental health care access.…”

“…younger users 16,17 ; 2. single or living by themselves 5,12,[18][19][20][21] ; and 3. those who have less contact with their families 19,22,23 .…”

Best Practices: The Washington Heights Community Service Model: Positive Outcomes and Implications for Reimbursement Under the ACA

“…Although studies in U.S. settings have had mixed findings (2), studies in other industrialized countries have shown that stays of less than eight days are associated with higher-than-average 30-day readmission rates, whereas stays between 25 and 30 days are not (13,14). Furthermore, a recent U.S. study showed that shorter hospitalizations lead to higher 30-day readmission rates (15). Evidence also suggests that the financial costs of longer hospitalizations are largely offset by lower readmission and emergency room utilization rates, not to mention less tangible benefits such as greater satisfaction with care, treatment retention, and improved quality of life (16).…”

Psychiatric Readmissions in a Community-Based Sample of Patients With Mental Disorders

“…Several patient-related factors are associated with readmission risk, including poor medication adherence (1); substance use disorders (1); a diagnosis of schizophrenia, bipolar disorder, or depression (4); and comorbid medical disorders (5). Homelessness or residence in an institutional setting are social factors associated with psychiatric readmission (2), and previous hospitalizations (6), length of hospital stay (7,8), and lack of adequate postdischarge care for psychiatric and substance use disorders are system-related factors (9).…”