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READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units.

Abstract：

:Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.

journal_name

J Psychiatr Res

journal_title

Journal of psychiatric research

authors

Vigod SN,Kurdyak PA,Seitz D,Herrmann N,Fung K,Lin E,Perlman C,Taylor VH,Rochon PA,Gruneir A

doi

10.1016/j.jpsychires.2014.12.003

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

205-13

eissn

0022-3956

issn

1879-1379

pii

S0022-3956(14)00344-6

journal_volume

61

pub_type

杂志文章

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