Abstract
BackgroundHigh levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates.MethodsStudies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates.ResultsOf the 760 articles identified by the initial search, 80 were selected for this review which included a total number of 59 different predictors of psychiatric readmission. Subsequently these were grouped into four categories: 1) individual vulnerability factors, 2) aftercare related factors, 3) community care and service responsiveness, and 4) contextual factors and social support. Individual factors were addressed in 58 papers and were found to be significant in 37 of these, aftercare factors were significant in 30 out of the 45 papers, community care and social support factors were significant in 21 out of 31 papers addressing these while contextual factors and social support were significant in all seven papers which studied them.ConclusionsThis review represents a first attempt at providing an overview of post-discharge factors previously studied in association with readmission. Hence, by mapping out the current research in the area, it highlights the gaps in research and it provides guidance future studies in the area.
Highlights
High levels of hospital readmission is widely used as indicator of a poor quality of care
The current review focused on post discharge variables with the aim to identify and categorise previously studied post-discharge factors in relation with readmission rates
221 were subsequently excluded based on exclusion criteria with a total number of 80 papers being included in the review
Summary
High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes referred to as recidivism or heavy utilization. The need for a systematic review of this evidence has become evident in the context of the Comparative Effectiveness research on Psychiatric HOSpitalisation by record LINKage of large administrative data sets (CEPHOSLINK) study, a FP7 funded EU project. The need for a more comprehensive understanding of all the factors impacting on readmission rates has motivated a series of reviews on readmission and the association with four different categories of factors: pre-discharge variables [9], post-discharge variables, system variables [10] and comorbidity [11]
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