0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
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
View Author and Article Information

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

Abstract

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.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Characteristics of 3,563 Florida Medicaid enrollees with schizophrenia
Anchor for Jump
Table 2Acute care readmissions (N=5,557) among 2,767 Florida Medicaid enrollees with schizophrenia
Anchor for Jump
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.

Anchor for Jump
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.

+

References

Durbin  J;  Lin  E;  Layne  C  et al:  Is readmission a valid indicator of the quality of inpatient psychiatric care? Journal of Behavioral Health Services and Research 34:137–150, 2007
[CrossRef] | [PubMed]
 
Schmutte  T;  Dunn  CL;  Sledge  WH:  Predicting time to readmission in patients with recent histories of recurrent psychiatric hospitalization: a matched-control survival analysis.  Journal of Nervous and Mental Disease 198:860–863, 2010
[CrossRef] | [PubMed]
 
Benbassat  J;  Taragin  M:  Hospital readmissions as a measure of quality of health care: advantages and limitations.  Archives of Internal Medicine 160:1074–1081, 2000
[CrossRef] | [PubMed]
 
Feigenbaum  P;  Neuwirth  E;  Trowbridge  L  et al:  Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals.  Medical Care 50:599–605, 2012
[CrossRef] | [PubMed]
 
Jencks  SF;  Williams  MV;  Coleman  EA:  Rehospitalizations among patients in the Medicare fee-for-service program.  New England Journal of Medicine 360:1418–1428, 2009
[CrossRef] | [PubMed]
 
Askren-Gonzalez  A;  Frater  J:  Case management programs for hospital readmission prevention.  Professional Case Management 17:219–226, quiz 227–228, 2012
[CrossRef] | [PubMed]
 
Weiden  PJ;  Olfson  M:  Cost of relapse in schizophrenia.  Schizophrenia Bulletin 21:419–429, 1995
[CrossRef] | [PubMed]
 
Schennach  R;  Obermeier  M;  Meyer  S  et al:  Predictors of relapse in the year after hospital discharge among patients with schizophrenia.  Psychiatric Services 63:87–90, 2012
[CrossRef] | [PubMed]
 
Valenstein  M;  Copeland  LA;  Blow  FC  et al:  Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission.  Medical Care 40:630–639, 2002
[CrossRef] | [PubMed]
 
Weiden  PJ;  Kozma  C;  Grogg  A  et al:  Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia.  Psychiatric Services 55:886–891, 2004
[CrossRef] | [PubMed]
 
Schmutte  T;  Dunn  C;  Sledge  W:  Characteristics of inpatients with a history of recurrent psychiatric hospitalizations: a matched-control study.  Psychiatric Services 60:1683–1685, 2009
[CrossRef] | [PubMed]
 
Figueroa  R;  Harman  J;  Engberg  J:  Use of claims data to examine the impact of length of inpatient psychiatric stay on readmission rate.  Psychiatric Services 55:560–565, 2004
[CrossRef] | [PubMed]
 
Maples  NJ;  Copeland  LA;  Zeber  JE  et al:  Can medication management coordinators help improve continuity of care after psychiatric hospitalization? Psychiatric Services 63:554–560, 2012
[CrossRef] | [PubMed]
 
Kim  YJ;  Soeken  KL:  A meta-analysis of the effect of hospital-based case management on hospital length-of-stay and readmission.  Nursing Research 54:255–264, 2005
[CrossRef] | [PubMed]
 
Prince  JD:  Practices preventing rehospitalization of individuals with schizophrenia.  Journal of Nervous and Mental Disease 194:397–403, 2006
[CrossRef] | [PubMed]
 
Charlson  ME;  Pompei  P;  Ales  KL  et al:  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.  Journal of Chronic Diseases 40:373–383, 1987
[CrossRef] | [PubMed]
 
Williams  RL:  A note on robust variance estimation for cluster-correlated data.  Biometrics 56:645–646, 2000
[CrossRef] | [PubMed]
 
Druss  BG;  Mauer  BJ:  Health care reform and care at the behavioral health—primary care interface.  Psychiatric Services 61:1087–1092, 2010
[CrossRef] | [PubMed]
 
Druss BG, Walker ER: Mental Disorders and Medical Comorbidity. Princeton, NJ, Synthesis Project, 2011. Available at www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf69438/subassets/rwjf69438_1
 
Flynn  PM;  Brown  BS:  Co-occurring disorders in substance abuse treatment: issues and prospects.  Journal of Substance Abuse Treatment 34:36–47, 2008
[CrossRef] | [PubMed]
 
Drake  RE;  Mueser  KT;  Brunette  MF  et al:  A review of treatments for people with severe mental illnesses and co-occurring substance use disorders.  Psychiatric Rehabilitation Journal 27:360–374, 2004
[CrossRef] | [PubMed]
 
Appleby  L;  Luchins  DJ;  Desai  PN  et al:  Length of inpatient stay and recidivism among patients with schizophrenia.  Psychiatric Services 47:985–990, 1996
[PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 38.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 33.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 1.  >
APA Practice Guidelines > Chapter 4.  >
APA Practice Guidelines > Chapter 4.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines
PubMed Articles