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J Psychiatr Res. 2015 Feb;61:205-13. doi: 10.1016/j.jpsychires.2014.12.003. Epub 2014 Dec 13.

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

Author information

1
Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada. Electronic address: simone.vigod@wchospital.ca.
2
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada.
3
Queens University, 99 University Avenue, Kingston, Ontario, Canada.
4
University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
5
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada.
6
University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada.
7
Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada.
8
Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; University of Alberta, 6-40 University Terrace, Edmonton, Alberta, Canada.

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.

KEYWORDS:

Psychiatric epidemiology; Psychiatric readmission; Risk index

[Indexed for MEDLINE]

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