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Perlman CM, Hirdes JP, Vigod S. Psychiatric Rehospitalization: Development of a Person-Level Indicator for Care Planning and Quality Assurance. Prim Care Companion CNS Disord. 2015;17(4)doi: 10.4088/PCC.15m01784.
Perlman, C. M., Hirdes, J. P., & Vigod, S. (2015). Psychiatric Rehospitalization: Development of a Person-Level Indicator for Care Planning and Quality Assurance. The primary care companion for CNS disorders, 17(4), . https://doi.org/10.4088/PCC.15m01784
Perlman, Christopher M, et al. "Psychiatric Rehospitalization: Development of a Person-Level Indicator for Care Planning and Quality Assurance." The primary care companion for CNS disorders vol. 17,4 (2015). doi: https://doi.org/10.4088/PCC.15m01784
Perlman CM, Hirdes JP, Vigod S. Psychiatric Rehospitalization: Development of a Person-Level Indicator for Care Planning and Quality Assurance. Prim Care Companion CNS Disord. 2015 Jul 23;17(4). doi: 10.4088/PCC.15m01784. eCollection 2015. PMID: 26693047; PMCID: PMC4664575.
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Prim Care Companion CNS Disord. 2015 Jul 23;17(4). doi: 10.4088/PCC.15m01784. eCollection 2015.

Psychiatric Rehospitalization: Development of a Person-Level Indicator for Care Planning and Quality Assurance.

The primary care companion for CNS disorders

Christopher M Perlman, John P Hirdes, Simone Vigod

Affiliations

  1. School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario (Drs Perlman and Hirdes); Women's College Research Institute, Women's College Hospital, Toronto; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Dr Vigod).

PMID: 26693047 PMCID: PMC4664575 DOI: 10.4088/PCC.15m01784

Abstract

OBJECTIVE: Rehospitalization affects quality of life and health system efficiency. Although this outcome is a common quality indicator, there are few applications for linking evaluation to risk mitigation at the person level. This study examined risk factors for rehospitalization to develop an application for supporting care planning based on the interRAI Mental Health (MH), a commonly available assessment system.

METHOD: A retrospective analysis was performed of 53,538 psychiatric inpatients assessed with the interRAI MH in Ontario, Canada, between January 2010 and May 2014. The interRAI MH is a clinical system for assessing demographic variables, service utilization, functional status, and clinical needs. Logistic regression models and survival analysis were used to develop the Rehospitalization Clinical Assessment Protocol by predicting 90-day rehospitalization to any inpatient mental health bed.

RESULTS: Variables found to significantly predict rehospitalization included 6 or more lifetime hospitalizations (odds ratio [OR] = 1.40), positive symptoms of psychosis (OR = 1.23), a secondary substance use disorder (OR = 1.13), and being at risk of harm to self (OR = 1.11). Using these variables, the Rehospitalization Clinical Assessment Protocol was derived whereby those at level 2 (highest) were 74% more likely to be rehospitalized within 90 days than those at level 0. By 1-year postdischarge, 30% at level 2 and 18% at level 0 were rehospitalized.

CONCLUSIONS: The Rehospitalization Clinical Assessment Protocol is an application supporting care planning for targeting risk of rehospitalization whenever a person is assessed with the interRAI MH. Further exploration is needed to understand how the use of this Clinical Assessment Protocol, service processes, and health system structures further mediate or moderate psychiatric rehospitalization risk.

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