Predicting psychiatric readmission: sex-specific models to predict 30-day readmission following acute psychiatric hospitalization

被引:22
作者
Barker, Lucy Church [1 ]
Gruneir, Andrea [2 ,3 ,4 ,5 ]
Fung, Kinwah [2 ,3 ]
Herrmann, Nathan [6 ]
Kurdyak, Paul [1 ,2 ,4 ,7 ]
Lin, Elizabeth [1 ,2 ,4 ,7 ]
Rochon, Paula A. [2 ,3 ,4 ,8 ]
Seitz, Dallas [9 ]
Taylor, Valerie H. [1 ,3 ]
Vigod, Simone N. [1 ,2 ,3 ,4 ]
机构
[1] Univ Toronto, Dept Psychiat, Toronto, ON, Canada
[2] Inst Clin Evaluat Sci, Toronto, ON, Canada
[3] Womens Coll Hosp, Womens Coll Hosp & Res Inst, 76 Grenville St, Toronto, ON M5S 1B2, Canada
[4] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[5] Univ Alberta, Dept Family Med, Edmonton, AB, Canada
[6] Sunnybrook Hlth Sci Ctr, Dept Psychiat, Toronto, ON, Canada
[7] Ctr Addict & Mental Hlth, Toronto, ON, Canada
[8] Univ Toronto, Dept Med, Toronto, ON, Canada
[9] Queens Univ, Dept Psychiat, Kingston, ON, Canada
关键词
Psychiatric readmission; Psychiatric epidemiology; Sex-based analysis; Sex differences; ADMINISTRATIVE DATA; AFTER-DISCHARGE; CASE-MANAGEMENT; RISK-FACTORS; HEALTH; GENDER; ADULTS; PREVALENCE; DIFFERENCE; DISORDERS;
D O I
10.1007/s00127-017-1450-5
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among women (n = 33,353) and men (n = 32,436) discharged from all psychiatric units in Ontario, Canada (2008-2011). Predictor variables included sociodemographics, health service utilization, and clinical characteristics. Using derivation data sets, multivariable logistic regression models were fit to determine optimal predictive models for each sex separately. Results were presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). The multivariable models were then applied in the internal validation data sets. The 30-day readmission rates were 9.3% (women) and 9.1% (men). Many predictors were consistent between women and men. For women only, personality disorder (aOR 1.21, 95% CI 1.03-1.42) and positive symptom score (aOR 1.41, 95% CI 1.09-1.82 for score of 1 vs. 0; aOR 1.44, 95% CI 1.26-1.64 for ae<yen> 2 vs. 0) increased odds of readmission. For men only, self-care problems at admission (aOR 1.20, 95% CI 1.06-1.36) and discharge (aOR 1.44, 95% CI 1.26-1.64 for score of 1 vs. 0; aOR 1.79, 95% CI 1.17-2.74 for 2 vs. 0), and mild anxiety rating (score of 1 vs. 0: aOR 1.30, 95% CI 1.02-1.64, derivation model only) increased odds of readmission. Models had moderate discriminative ability in derivation and internal validation samples for both sexes (c-statistics 0.64-0.65). Certain key predictors of psychiatric readmission differ by sex. This knowledge may help to reduce psychiatric hospital readmission rates by focusing interventions.
引用
收藏
页码:139 / 149
页数:11
相关论文
共 35 条
[1]  
Allison, 2013, WHY I DONT TRUST HOS
[2]  
[Anonymous], 2000, DIAGN STAT MAN MENT, DOI DOI 10.1176/APPI.BOOKS.9780890423349
[3]  
[Anonymous], 2011, HLTH IND 2011
[4]  
[Anonymous], 2013, Education at a Glance 2013: OECD Indicators
[5]   Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research [J].
Austin, Peter C. .
COMMUNICATIONS IN STATISTICS-SIMULATION AND COMPUTATION, 2009, 38 (06) :1228-1234
[6]   Life-course theory of readmission of substance abusers among homeless veterans [J].
Benda, BB .
PSYCHIATRIC SERVICES, 2004, 55 (11) :1308-1310
[7]   The Triple Aim: Care, health, and cost [J].
Berwick, Donald M. ;
Nolan, Thomas W. ;
Whittington, John .
HEALTH AFFAIRS, 2008, 27 (03) :759-769
[8]   Elderly Medicare inpatients with substance use disorders: Characteristics and predictors of hospital readmissions over a four-year interval [J].
Brennan, PL ;
Kagay, CR ;
Geppert, JJ ;
Moos, RH .
JOURNAL OF STUDIES ON ALCOHOL, 2000, 61 (06) :891-895
[9]   An examination of risk factors for readmission to acute adult mental health services within 28 days of discharge in the Australian setting [J].
Callaly, Tom ;
Trauer, Tom ;
Hyland, Mary ;
Coombs, Tim ;
Berk, Michael .
AUSTRALASIAN PSYCHIATRY, 2011, 19 (03) :221-225
[10]   Reporting Sex, Gender, or Both in Clinical Research? [J].
Clayton, Janine Austin ;
Tannenbaum, Cara .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 316 (18) :1863-1864