• Do patients with serious mental illnesses get readmitted to the hospital more?

    Quotes from Serious Mental Illness [SMI] and Acute Hospital Readmission in Diabetic Patients, by Jennifer Albrecht, et al.:

    • SMI, which includes schizophrenia and bipolar disorder, is associated with decreased capacity for self-care, lack of access to medical care, and poorer quality of care received, all of which may be associated with hospital readmission.[7-9]
    • Previous research has suggested that patients with diabetes and SMI may receive lower quality of care for their diabetes than patients without SMI, thereby placing them at increased risk for hospital readmission.[10,11]
    • The authors conducted a retrospective cohort study that included all adult (≥18 years of age) admissions with diabetes to the University of Maryland Medical Center (UMMC) between February 1, 2005, and January 31, 2009.
    • Therefore, patients who died during their index hospitalization were excluded because they were no longer at risk of readmission.
    • [R]esults of our adjusted model suggested that adults with diabetes and SMI who were younger than 35 years of age were at significantly decreased risk of 30-day hospital readmission compared with those without SMI. However, among patients aged 35 years and older, SMI was not significantly associated with 30-day hospital readmission.
    • Our findings are consistent with those of Abrams et al,[14,15] who observed that comorbid psychiatric conditions identified using hospital inpatient records were not associated with 30-day mortality in Veterans Health Administration hospital patients admitted for acute myocardial infarction or nonsurgical intensive care. Furthermore, Blecker et al[16] observed no association between SMI and quality of care, including hospital readmission, for disabled Medicaid recipients with heart failure.
    • Individuals with SMI die, on average, 25 years earlier than people who do not have SMI.[7] Thus, older and potentially sicker patients with SMI who may have been at greater risk for hospital readmission may have died already.
    • Our observation of no association between a diagnosis of SMI and 30-day hospital readmissions in adults with diabetes older than age 35 contrasts with the positive associations reported by Saravay et al20 and Rathore et al.[21]
    • Borckardt et al[22] reported a positive association between outpatient psychiatric visits and hospital admissions in a retrospective study of a single hospital population.
    • Abrams et al,[14,15,25] the method used to identify mental illness can have a significant impact on observed results. Using outpatient records resulted in a significant association between SMI and 30-day mortality in Veterans Health Administration hospital patients, whereas using inpatient records did not.

    Comments:

    • This was a study of diabetic patients only. Results for other conditions may differ.
    • This was a study of patients at just one facility. Results at other facilities may differ.
    • It seems important to include outpatient records to identify mental illness. It doesn’t seem like that was done on this study, but I didn’t find that made explicit in the paper.
    • Based on the literature summarized in this paper, there is no consensus whether SMI patients have increased readmissions or not.
    • Excluding patients who died during their index admission seems like a mistake if SMI patients are at elevated risk of death. On the reasonable assumption that patients who die are otherwise at an elevated risk of readmission, censoring by death biases the results toward finding a lower readmission rate among SMI patients.

    @afrakt

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