The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Abstract

This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, post-discharge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords inpatient psychiatric hospitalization; adolescents; readmissionIt is estimated that 24% to 37% of youths will be readmitted to a psychiatric hospital within one year after discharge, and latest data suggest that rates of readmission are increasing despite cost-containment efforts and emphasis on community-based treatment alternatives (Blader, 2004;Fontanella, Zuravin, & Burry, 2006;Pavkov, Goerge, Lee, & Howard, 1994; Soloman, Evans, & Delaney, 1993). In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services (Ringel & Sturm, 2001).Some researchers speculate that the increased readmission rates can be attributed to premature discharges resulting from shortened lengths of stay (Appley, Desai, Luchins, Gibbons, & Hedeker, 1993;Lien, 2002;Wickizer, Lessler, & Boyd-Wickizer, 1999). In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increasesCorrespondence concerning this article should be addressed to Cynthia A. Fontanella, College of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210. E-mail: fontanella.4@osu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. ...

Adherence of 13–17 Year Old Adolescents to Medicinal and Non-pharmacological Treatment in Psychiatric Inpatient Care: Special Focus on Relative Clinical and Family Factors

“…Also, there was no relationship between adherence and duration of treatment. An awareness of such a relationship might help improve adherence because adolescents who are hospitalized for longer periods of time are more likely to be readmitted [49].…”

Factors that Affect Adolescent Adherence to Mental Health and Psychiatric Treatment: a Systematic Integrative Review of the Literature

“…The severity of positive psychotic symptoms was not significantly associated with adherence (49). Readmission is also negatively associated with adherence, because adherent patients have a reduced risk of rehospitalization (13).…”

“…Increased severity of illness was associated with a higher risk of readmission among adolescents (13). Sellwood and colleagues (9) found that overall symptom severity was not related to non-adherence, but they also found that non-adherent patients tended to have more severe psychotic symptoms as compared with adherent patients.…”

“…Passive acceptance in adults might be related to attitudes toward taking prescribed medication during inpatient treatment; however, attitudes can change after discharge (43). Adolescents prefer to be treated as individuals and in a nonjudgmental manner-in other words, as people rather than as patients (13,16). This type of treatment may influence the desire of adolescents to participate in the referred and prescribed regimens.…”

“…The period between discharge from inpatient care and engagement with follow-up treatment is especially critical; it is also a vulnerable time for patients with mental illness who require long-term care (8). Especially among adolescents, more information is needed to understand the factors that contribute to readmission (13). According to Gearing and colleagues (14), approximately a third of adolescents do not complete recommended psychosocial treatment.…”