Open AccessThe Influence of Clinical, Treatment, and Healthcare System Characteristics on Psychiatric Readmission of Adolescents
Author(s) -
Fontanella Cynthia A.
Publication year - 2008
Publication title -
american journal of orthopsychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.959
H-Index - 93
eISSN - 1939-0025
pISSN - 0002-9432
DOI - 10.1037/a0012557
Subject(s) - medicaid , medicine , medical record , comorbidity , multivariate analysis , bivariate analysis , hospital readmission , psychiatry , logistic regression , health care , proportional hazards model , emergency medicine , statistics , mathematics , economics , economic growth
This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and the Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One‐year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, postdischarge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes.