Rapid versus delayed readmission in first-admission psychosis: quality indicators for managed care?

This study examined clinical correlates of rapid readmission to a psychiatric inpatient service (less than 3 months after discharge) compared to delayed readmissions (3-12 months) in first-admission patients diagnosed with schizophrenia, bipolar disorder with psychosis, and major depression with psychosis. After reviewing the clinical records and research summaries of all patients who were readmitted withine 1 year of discharge, we compared the two readmission groups with respect to demographic and clinical characteristics and subsequent clinical course. Rapid readmission was significantly associated with instability of clinical condition at first discharge (especially mood symptoms) and, to a lesser degree, with failure to prescribe specific medication for affective psychosis patients. Regardless of duration of community tenure, readmission was strongly associated with medication nonprescription or discontinuation. The results suggest that managed care protocols aimed at preventing rapid readmission may require specific symptom assessment and pharmacotherapeutic intervention during the initial hospitalization. Readmission can be used as a quality indicator of both clinical processes (hospital vand outpatient care) so long as duration of community tenure prior to readmission is taken into account.