READMIT: A clinical risk index to predict 30-day readmission after discharge from acute psychiatric units. (February 2015)

• Record Type: Journal Article
• Authors: Vigod, Simone N.; Kurdyak, Paul A.; Seitz, Dallas; Herrmann, Nathan; Fung, Kinwah; Lin, Elizabeth; Perlman, Christopher; Taylor, Valerie H.; Rochon, Paula A.; Gruneir, Andrea
• Is Part Of: Journal of psychiatric research. Volume 61(2015:Feb.)
• Page Start: 205
• Page End: 213
• Publication Date: 2015-02
• Subjects: Psychiatric readmission -- Psychiatric epidemiology -- Risk index; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2014.12.003
• Languages: English
• ISSNs: 0022-3956

Abstract

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. Highlights: READMIT is a clinical risk score for determining risk for 30-day psychiatric readmission. Each 1-point increase in READMIT score (range 0–41) increases risk of readmission by 11%. READMIT items are feasible to collect in multiple clinical settings to flag at-risk patients. READMIT can be used to identify target populations for research studies aimed at reducing readmission. READMIT can be used on a system-level to align programs to areas of need.