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Risk Factors for Early Readmission to Acute Care for Persons With Schizophrenia Taking Antipsychotic Medications
Timothy L. Boaz, Ph.D.; Marion Ann Becker, Ph.D.; Ross Andel, Ph.D.; Richard A. Van Dorn, Ph.D.; Jiyoon Choi, Pharm.D.; Mirko Sikirica, Pharm.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.003382012
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Dr. Boaz is with the Department of Mental Health Law and Policy, Dr. Becker is with the School of Social Work, and Dr. Andel is with the Department of Aging Studies, all at the University of South Florida (USF), Tampa. Dr. Andel is also with the International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic. Dr. Van Dorn is with Behavioral Health Epidemiology at RTI International, Research Triangle Park, North Carolina. Dr. Choi is with Ortho-McNeil Janssen Scientific Affairs, Titusville, New Jersey, where Dr. Sikirica was affiliated when this work was done. Dr. Sikirica is now with Bayer HealthCare Pharmaceuticals, Berlin, Germany. Send correspondence to Dr. Boaz at USF, 13301 Bruce B. Downs Blvd., Tampa, FL 33612-3807 (e-mail: boaz@usf.edu). Portions of this study were presented at the annual meeting of the U.S. Psychiatric and Mental Health Congress, Orlando, Florida, November 18–21, 2010.

Copyright © 2013 by the American Psychiatric Association


Objective  The study examined risk factors for readmission to acute care among Florida Medicaid enrollees with schizophrenia treated with antipsychotics.

Methods  Medicaid and service use data for 2004 to 2008 were used to identify adults with schizophrenia discharged from hospitals and crisis units who were taking antipsychotics. Data were extracted on demographic characteristics, service use before admission, psychopharmacologic treatment after discharge, and readmission to acute behavioral health care. Cox proportional hazards regression estimated readmission risk in the 30 days after discharge and in the period after 30 days for participants not readmitted in the first 30 days.

Results  The mean±SD age of the 3,563 participants was 43.4±11.1; 61% were male, and 38% were white. Participants had 6,633 inpatient episodes; duration of hospitalization was 10.6±7.0 days. Readmission occurred for 84% of episodes, 23% within 30 days. Variables associated with an increased readmission risk in the first 30 days were shorter hospitalization (hazard ratio [HR]=1.18, 95% confidence interval [CI]=1.10–1.27, p<.001), shorter time on medication before discharge (HR=1.19, CI=1.06–1.35, p=.003), greater prehospitalization use of acute care (HR=2.64, CI=2.29–3.05, p<.001), serious general medical comorbidity (HR=1.21, CI=1.06–1.38, p=.005), and prior substance abuse treatment (HR=1.58, CI=1.37–1.83, p<.001). After 30 days, hospitalization duration and time on medication were not significant risk factors.

Conclusions  Short hospital stays for persons with schizophrenia may be associated with risk of early readmission, possibly because the person is insufficiently stabilized. More chronic risk factors include prior acute care, general medical comorbidity, and substance abuse.

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Anchor for Jump
Table 1Characteristics of 3,563 Florida Medicaid enrollees with schizophrenia
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Table 2Acute care readmissions (N=5,557) among 2,767 Florida Medicaid enrollees with schizophrenia
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Table 3Cox proportional hazards analysis of risk of readmission within 30 days among Florida Medicaid enrollees with schizophreniaa
Table Footer Note

a All 6,633 episodes of acute care were included in the analysis.

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Table 4Cox proportional hazards analysis of risk of readmission after 30 days among Florida Medicaid enrollees with schizophreniaa
Table Footer Note

a The 1,490 episodes in which the person was readmitted within 30 days were excluded from this analysis. The remaining 5,143 episodes of acute care were included.



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