Abstract

BackgroundPsychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China.MethodsData on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics.ResultsThe 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04–1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56–0.91) and frequent readmissions (OR 0.60, 95%CI 0.40–0.91).ConclusionMore than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.

Highlights

  • Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs

  • Main findings This study investigated the factors associated with risk of psychiatric readmission within 30 days and 1 year after the index admissions in the regional all-payer database of Beijing, China

  • Hospital characteristics We found that index admission in tertiary hospitals was significantly associated with 30-day and frequent readmissions in this study

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Summary

Introduction

Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China. Psychiatric patients are prone to readmissions [2]: almost 1 in 7 psychiatric patients needed to be rehospitalized within 30 days of discharge [3], and around 40% of the patients were readmitted 1 year after the index admissions [4]. Repeated hospitalizations for patients with psychiatric disorders may reflect the nature and course of the illnesses, socio-demographic or environmental factors, underlying inefficiencies during the hospitalization and in the pre- and post-discharge settings may play a role [6]. As for the frequency of readmissions, Langdon et al considered the patients that experienced three or more admissions a year to be “the revolving door” patients [11]

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