Patient- and hospital-level factors are associated with single and multiple youth inpatient psychiatric readmission, according to research findings published in the Journal of the American Academy of Child & Adolescent Psychiatry. The findings suggest potential risk markers for psychiatric readmission that could inform the development of future interventions to reduce inpatient psychiatric readmission rates in youth with mood disorders.

Researchers analyzed data from a retrospective cohort study of Medicaid data from four states, along with the American Hospital Association survey, the Area Resource File, and the National Survey of Mental Health Treatment Services. Using multinomial logistic regression, they examined patient-, hospital-, and community-level factors associated with inpatient psychiatric readmission. The data included 6797 youth with a primary diagnosis of a mood disorder.

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Within six months after discharge, 941 youth (13.8%) were readmitted once and 471 (6.9%) were admitted multiple times. The mean ±standard deviation age of the 1412 youth who were readmitted was 14.0±2.5 years; 55.6% were female; and 36.2% were non-Hispanic white. The odds of readmission were significantly higher in participants who were in foster care, had psychiatric and/or medical comorbidity, were classified as disabled, or had a prior psychiatric hospitalization. Treatment in hospitals with a high number of beds and a high percentage of Medicaid discharges was associated with a lower rate of readmission. Length of stay was associated with outpatient mental health follow-up within 7 days following discharge.

The study was limited by its observational nature, which does not allow for causal inferences. The cohort was limited to Medicaid-enrolled youth in four states and, therefore, the findings may not be generalizable.

These findings can inform the design and implementations of interventions. “A validated and practical predictive model combined with corresponding process changes has potential to decrease the revolving door phenomenon some psychiatrically hospitalized youth experience,” the researchers wrote.  They concluded, “Such efforts could not only decrease the burden of mental illness for youth and families, but also improve service efficiency and decrease mental health care costs.”

Reference

Phillips MS, Steelesmith DL, Campo JV, Pradhan T, Fontanella CA. Factors associated with multiple psychiatric readmissions for youths with mood disorders [published online June 3, 2019]. J Am Acad Child Adolesc Psychiatry. doi:10.1016/j.jaac.2019.05.024