Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature

Authors: Jorid Kalseth, Eva Lassemo, Kristian Wahlbeck, Peija Haaramo, Jon Magnussen

Published in: BMC Psychiatry | Issue 1/2016

Login to get access

Abstract

Background

Psychiatric readmissions have been studied at length. However, knowledge about how environmental and health system characteristics affect readmission rates is scarce. This paper systemically reviews and discusses the impact of health and social systems as well as environmental characteristics for readmission after discharge from inpatient care for patients with a psychiatric diagnosis.

Methods

Comprehensive literature searches were conducted in the electronic bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. In addition, Google Scholar was utilised. Relevant publications published between January 1990 and June 2014 were included. No restrictions regarding language or publication status were imposed. A qualitative synthesis of the included studies was performed. Variables describing system and environmental characteristics were grouped into three groups: those capturing regulation, financing system and governance; those capturing capacity, organisation and structure; and those capturing environmental variables.

Results

Of the 734 unique articles identified in the original search, 35 were included in the study. There is a limited number of studies on psychiatric readmissions and their association with environmental and health system characteristics. Even though the review reveals an extensive list of characteristics studied, most characteristics appear in a very limited number of articles. The most frequently studied characteristics are related to location (local area, district/region/country). In most cases area differences were found, providing strong indication that the risk of readmission not only relates to patient characteristics but also to system and/or environmental factors that vary between areas. The literature also points in the direction of a negative association of institutional length of stay and community aftercare with readmission for psychiatric patients.

Conclusion

This review shows that analyses of system level variables are scarce. Furthermore they differ with respect to purpose, choice of system characteristics and the way these characteristics are measured. The lack of studies looking at the relationship between readmissions and provider payment models is striking. Without the link to provider payment models and other health system characteristics related to regulation, financing system and governance structure it becomes more difficult to draw policy implications from these analyses.
Appendix
Available only for authorised users
Literature
1.
Machado V, Leonidas C, Santos MA, Santos MA, Souza J. Psychiatric readmission: an integrative review of the literature. Int Nurs Rev. 2012;59:447–57.CrossRefPubMed
2.
Durbin J, Lin E, Layne C, Teed M. Is readmission a valid indicator of the quality of inpatient psychiatric care? J Behav Health Serv Res. 2007;34:137–50.CrossRefPubMed
3.
Rumball-Smith J, Hider P. The validity of readmission rate as a marker of the quality of hospital care, and a recommendation for its definition. NZ Med J. 2009;122:63–70.
4.
5.
Bradley EH, Curry L, Horwitz LI, Sipsma H, Thompson JW, Elma M, et al. Contemporary evidence about hospital strategies for reducing 30-day readmissions: a national study. J Am Coll Cardiol. 2012;60:607–14.CrossRefPubMedPubMedCentral
6.
7.
Klinkenberg WD, Calsyn RJ. Predictors of receipt of aftercare and recidivism among persons with severe mental illness: A review. Psychiatr Serv. 1996;47:487–96.CrossRefPubMed
8.
Lien L. Are readmission rates influenced by how psychiatric services are organized? Nord J Psychiatry. 2002;56:23–8.CrossRefPubMed
9.
Frick U, Frick H, Langguth B, Landgrebe M, Hübner-Liebermann B, Hajak G. The revolving door phenomenon revisited: time to readmission in 17’415 Patients with 37’697 Hospitalisations at a German Psychiatric Hospital. PLoS One. 2013;8:1–9.CrossRef
10.
11.
Grinshpoon A, Abramowitz MZ, Lerner Y, Zilber N. Re-hospitalization of first-in-life admitted schizophrenic patients before and after rehabilitation legislation: a comparison of two national cohorts. Soc Psychiatry Psychiatr Epidemiol. 2007;42:355–9.CrossRefPubMed
12.
Merrick EL. Effects of a behavioral health carve-out on inpatient-related quality indicators for major depression treatment. Med Care. 1999;37:1023–33.CrossRefPubMed
13.
Wickizer TM, Lessler D. Do treatment restrictions imposed by utilization management increase the likelihood of readmission for psychiatric patients? Med Care. 1998;36:844–50.CrossRefPubMed
14.
Peterson KA, Swindle RW, Phibbs CS, Recine B, Moos RH. Determinants of readmission following inpatient substance abuse treatment: a national study of VA programs. Med Care. 1994;32:535–50.CrossRefPubMed
15.
Lee HC, Lin HC. Is the volume-outcome relationship sustained in psychiatric care? Soc Psychiatry Psychiatr Epidemiol. 2007;42:669–72.CrossRefPubMed
16.
Mark T, Tomic KS, Kowlessar N, Chu BC, Vandivort-Warren R, Smith S. Hospital readmission among medicaid patients with an index hospitalization for mental and/or substance use disorder. J Behav Health Serv Res. 2013;40:207–21.CrossRefPubMed
17.
Moos RH, Mertens JR, Brennan PL. Program characteristics and readmission among older substance abuse patients: comparisons with middle-aged and younger patients. J Ment Health Adm. 1995;22:332–45.CrossRefPubMed
18.
Oiesvold T, Saarento O, Sytema S, Vinding H, Gostas G, Lonnerberg O, et al. Predictors for readmission risk of new patients: the Nordic Comparative Study on Sectorized Psychiatry. Acta Psychiatr Scand. 2000;101:367–73.CrossRefPubMed
19.
Turner JT, Wan TT. Recidivism and mental illness: the role of communities. Community Ment Health J. 1993;29:3–14.CrossRefPubMed
20.
Wan TT, Ozcan YA. Determinants of psychiatric rehospitalization: a social area analysis. Community Ment Health J. 1991;27:3–16.CrossRefPubMed
21.
Ruesch P, Meyer PC, Hell D. [Who is rehospitalized in a psychiatric hospital? Psychiatric hospitalization rates and social indicators in the Zurich canton (Switzerland)]. Gesundheitswesen. 2000;62:166–71.CrossRefPubMed
22.
Fisher WH, Geller JL, Altaffer F, Bennett MB. The relationship between community resources and state hospital recidivism. Am J Psychiatry. 1992;149:385–90.CrossRefPubMed
23.
Prince JD, Akincigil A, Kalay E, Walkup JT, Hoover DR, Lucas J, et al. Psychiatric rehospitalization among elderly persons in the United States. Psychiatr Serv. 2008;59:1038–45.CrossRefPubMed
24.
Heggestad T. Operating conditions of psychiatric hospitals and early readmission--effects of high patient turnover. Acta Psychiatr Scand. 2001;103:196–202.CrossRefPubMed
25.
Lin H-C, Lee H-C. Psychiatrists’ caseload volume, length of stay and mental healthcare readmission rates: A three-year population-based study. Psychiatry Res. 2009;166:15–23.CrossRefPubMed
26.
Niehaus DJ, Koen L, Galal U, Dhansay K, Oosthuizen PP, Emsley RA, et al. Crisis discharges and readmission risk in acute psychiatric male inpatients. BMC Psychiatry. 2008;8:44.CrossRefPubMedPubMedCentral
27.
Lin HC, Tian WH, Chen CS, Liu TC, Tsai SY, Lee HC. The association between readmission rates and length of stay for schizophrenia: a 3-year population-based study. Schizophr Res. 2006;83:211–4.CrossRefPubMed
28.
Lin CH, Chen WL, Lin CM, Lee MD, Ko MC, Li CY. Predictors of psychiatric readmissions in the short- and long-term: a population-based study in Taiwan. Clin (Sao Paulo). 2010;65:481–9.CrossRef
29.
Gillis LS, Koch A, Joyi M. The value and cost-effectiveness of a home-visiting programme for psychiatric patients. S Afr Med J. 1990;77:309–10.PubMed
30.
Reynolds W, Lauder W, Sharkey S, MacIver S, Veitch T, Cameron D. The effects of a transitional discharge model for psychiatric patients. J Psychiatr Ment Health Nurs. 2004;11:82–8.CrossRefPubMed
31.
Tomita A, Lukens EP, Herman DB. Mediation analysis of critical time intervention for persons living with serious mental illnesses: Assessing the role of family relations in reducing psychiatric rehospitalization. Psychiatr Rehabil J. 2014;37:4–10.CrossRefPubMed
32.
Kolbasovsky A. Reducing 30-day inpatient psychiatric recidivism and associated costs through intensive case management. Prof Case Manag. 2009;14:96–105.CrossRefPubMed
33.
Patterson DA, Lee M-S. Intensive case management and rehospitalization: a survival analysis. Res Soc Work Pract. 1998;8:152–71.CrossRef
34.
Rossler W, Loffler W, Fatkenheuer B, Riecher-Rossler A. Case management for schizophrenic patients at risk for rehospitalization: a case control study. Eur Arch Psychiatry Clin Neurosci. 1995;246:29–36.CrossRefPubMed
35.
Schmidt-Kraepelin C, Janssen B, Gaebel W. Prevention of rehospitalization in schizophrenia: results of an integrated care project in Germany. Eur Arch Psychiatry Clin Neurosci. 2009;259:S205–12.CrossRefPubMed
36.
Papageorgiou A, King M, Janmohamed A, Davidson O, Dawson J. Advance directives for patients compulsorily admitted to hospital with serious mental illness. Randomised controlled trial. Br J Psychiatry. 2002;181:513–9.CrossRefPubMed
37.
Eaton WW, Mortensen PB, Herrman H, Freeman H, Bilker W, Burgess P, et al. Long-term course of hospitalization for schizophrenia: Part I. Risk for rehospitalization. Schizophr Bull. 1992;18:217–28.CrossRefPubMed
38.
Sytema S, Burgess P. Continuity of care and readmission in two service systems: a comparative Victorian and Groningen case-register study. Acta Psychiatr Scand. 1999;100:212–9.CrossRefPubMed
39.
Sytema S, Burgess P, Tansella M. Does community care decrease length of stay and risk of rehospitalization in new patients with schizophrenia disorders? A comparative case register study in Groningen, The Netherlands; Victoria, Australia; and South-Verona, Italy. Schizophr Bull. 2002;28:273–81.CrossRefPubMed
40.
Zilber N, Hornik-Lurie T, Lerner Y. Predictors of early psychiatric rehospitalization: a national case register study. Isr J Psychiatry Relat Sci. 2011;48:49–53.PubMed
41.
Korkeila JA, Lehtinen V, Tuori T, Helenius H. Frequently hospitalised psychiatric patients: a study of predictive factors. Soc Psychiatry Psychiatr Epidemiol. 1998;33:528–34.CrossRefPubMed
42.
Thornicroft G, Gooch C, Dayson D. The TAPS project. 17: Readmission to hospital for long term psychiatric patients after discharge to the community. BMJ. 1992;305:996–8.CrossRefPubMedPubMedCentral
43.
Husted J, Jorgens A. Population density as a factor in the rehospitalization of persons with serious and persistent mental illness. Psychiatr Serv. 2000;51:603–5.CrossRefPubMed
44.
Stahler GJ, Mennis J, Cotlar R, Baron DA. The influence of neighborhood environment on treatment continuity and rehospitalization in dually diagnosed patients discharged for acute inpatient care. Am J Psychiatry. 2009;166:1258–68.CrossRefPubMed
45.
Hodgson R, Lewis M, Boardman A. Prediction of readmission to acute psychiatric units. Soc Psychiatry Psychiatr Epidemiol. 2001;36:304–9.CrossRefPubMed
46.
Knapp M, Chisholm D, Astin J, Lelliott P, Audini B. The cost consequences of changing the hospital–community balance: the mental health residential care study. Psychol Med. 1997;27:681–92.CrossRefPubMed
47.
Capdevielle D, Ritchie K, Villebrun D, Boulenger JP. The long and the short of it: are shorter periods of hospitalisation beneficial? Br J Psychiatry. 2008;192:164–5.CrossRefPubMed
48.
Vigod SN, Kurdyak PA, Dennis C-L, Leszcz T, Taylor VH, Blumberger DM, et al. Transitional interventions to reduce early psychiatric readmissions in adults: systematic review. Br J Psychiatry. 2013;202:187–94.CrossRefPubMed
49.
Metadata
Title
Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature
Authors
Jorid Kalseth
Eva Lassemo
Kristian Wahlbeck
Peija Haaramo
Jon Magnussen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-1099-8

Other articles of this Issue 1/2016

BMC Psychiatry 1/2016 Go to the issue

Research article

Differential expression of the inflammation marker IL12p40 in the at-risk mental state for psychosis: a predictor of transition to psychotic disorder?

Debate

A debate on working memory and cognitive control: can we learn about the treatment of substance use disorders from the neural correlates of anorexia nervosa?

Research article

The effects of low-intensity narrow-band blue-light treatment compared to bright white-light treatment in sub-syndromal seasonal affective disorder

Research article

Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period

Research article

The effect of oxytocin on attention to angry and happy faces in chronic depression

Research article

Development of a measure of model fidelity for mental health Crisis Resolution Teams