October 3, 2018Journal for Healthcare Quality47 citationsOpen Access

Predictors of 30-day Postdischarge Readmission to a Multistate National Sample of State Psychiatric Hospitals

Structured PICO

Population

60,254 discharges of adults aged 18 to 64 years from 127 state-operated or state-supported psychiatric hospitals in 39 states in the United States, between January 1 and December 31, 2014. Mean age 38.0 years, 63.1% male.

Outcome

30-day readmission to the same psychiatric hospital after discharge

Short length of stay, specific psychiatric diagnoses, and non-private living arrangements are significant predictors of 30-day readmission to state psychiatric hospitals.

Limitations

Generalization could be limited for other psychiatric inpatient providers
Analyzed discharges, not the unique count of patients
Readmission period was limited to 30 days after discharge
Other possible predictors were not available
Seventeen percent of hospitals were not included because they submitted samples for the continuing care plan data
Analysis accounted for a small part of the variability in the outcome measure

Abstract

BACKGROUND: Early discharge from psychiatric inpatient care may pose challenges for the patient's recovery and may incite a rapid return to the hospital. This study identified demographic, clinical, and the continuing of care characteristics associated with rapid readmission into a sample of psychiatric inpatient hospitals. METHODS: Cross-sectional analysis of 60,254 discharges from state psychiatric hospitals. Logistic regression explored the relationship between predictors of rapid readmission. RESULTS: Eight percent of discharges were readmitted to the same hospital within 30 days after discharge. Factors significantly related with rapid readmission included white (odds ratio, 1.23; 95% confidence interval, 1.13-1.34), non-Hispanic (1.48, 1.26-1.73), not married (1.53, 1.32-1.76), voluntarily admitted (1.18, 1.05-1.33), with length of stay (LOS) ≤ 7 days (3.52, 3.04-4.08), or LOS 8-31 days (3.20, 2.79-3.66), or LOS 32-92 days (1.91, 1.65-2.22), with a schizophrenia or other psychotic disorders (1.69, 1.46-1.96) or personality disorder (1.76, 1.50-2.06), referred to a setting different from the outpatient (1.27, 1.16-1.40), or with a living arrangement different from private residence (1.54, 1.40-1.68). CONCLUSIONS: Disparities in rapid readmission rates exist among state psychiatric hospitals. A national overview of the individuals with mental illness at risk of being prematurely discharged may suggests insights into quality initiatives aimed at reducing rapid readmissions into psychiatric inpatient care.

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