Paul Kurdyak1, Simone Natalie Vigod1, Alice Newman1, Vasily Giannakeas1, Benoit H Mulsant1, Therese Stukel1. 1. Dr. Kurdyak is with the Centre for Addiction and Mental Health and the Institute for Clinical Evaluation, Toronto. Dr. Vigod is with the Department of Psychiatry, Women's College Hospital, Toronto. She is also with the Department of Psychiatry, University of Toronto, where Dr. Mulsant is affiliated. Ms. Newman, Mr. Giannakeas, and Dr. Stukel are with the Institute for Clinical Evaluative Sciences, Toronto.
Abstract
OBJECTIVE: The study evaluated the association between physician follow-up within 30 days after hospital discharge and psychiatric readmission within the subsequent 180 days. METHODS: Among inpatients with schizophrenia who were discharged between 2007 and 2012 in Ontario (N=19,132), those who had a 30-day follow-up visit with a primary care physician (PCP) only, a psychiatrist only, or both were compared with a no-follow-up group. The primary outcome was psychiatric readmission in the subsequent 180 days. Secondary analyses stratified the sample on the basis of readmission risk at discharge. RESULTS: About 65% of patients had follow-up care within 30 days postdischarge. Psychiatric readmission rates were similar among patients with any physician follow-up and significantly lower than among those with no follow-up (26%): PCP only: 22%; adjusted hazard ratio [aHR]=.88, 95% confidence interval [CI]=.81-.96; psychiatrist only, 22%; aHR=.84, CI=.77-.90; both, 21%, aHR=.82, CI=.75-.90). In stratified analyses, 66% of patients were in the category at highest risk of psychiatric readmission, and the effect of follow-up with any physician was significant for these patients, compared with high-readmission risk patients with no follow-up, who had a 29% readmission rate (PCP only, 20% readmission rate, aHR=.85, CI=.77-.94; psychiatrist only, 29%, aHR=.84, CI=.77-.92; both, 17%, aHR=.81, CI=.73-.90). DISCUSSION: Timely physician follow-up was associated with reduced risk of psychiatric readmissions, with the greatest reduction among patients at high risk of readmission. Because more than one-third of patients had no physician visit within 30 days postdischarge, improving physician follow-up may help reduce psychiatric readmission rates.
OBJECTIVE: The study evaluated the association between physician follow-up within 30 days after hospital discharge and psychiatric readmission within the subsequent 180 days. METHODS: Among inpatients with schizophrenia who were discharged between 2007 and 2012 in Ontario (N=19,132), those who had a 30-day follow-up visit with a primary care physician (PCP) only, a psychiatrist only, or both were compared with a no-follow-up group. The primary outcome was psychiatric readmission in the subsequent 180 days. Secondary analyses stratified the sample on the basis of readmission risk at discharge. RESULTS: About 65% of patients had follow-up care within 30 days postdischarge. Psychiatric readmission rates were similar among patients with any physician follow-up and significantly lower than among those with no follow-up (26%): PCP only: 22%; adjusted hazard ratio [aHR]=.88, 95% confidence interval [CI]=.81-.96; psychiatrist only, 22%; aHR=.84, CI=.77-.90; both, 21%, aHR=.82, CI=.75-.90). In stratified analyses, 66% of patients were in the category at highest risk of psychiatric readmission, and the effect of follow-up with any physician was significant for these patients, compared with high-readmission risk patients with no follow-up, who had a 29% readmission rate (PCP only, 20% readmission rate, aHR=.85, CI=.77-.94; psychiatrist only, 29%, aHR=.84, CI=.77-.92; both, 17%, aHR=.81, CI=.73-.90). DISCUSSION: Timely physician follow-up was associated with reduced risk of psychiatric readmissions, with the greatest reduction among patients at high risk of readmission. Because more than one-third of patients had no physician visit within 30 days postdischarge, improving physician follow-up may help reduce psychiatric readmission rates.
Entities:
Keywords:
Outcome studies; Schizophrenia; Service delivery systems
Authors: Thomas E Smith; Morgan Haselden; Tom Corbeil; Fei Tang; Marleen Radigan; Susan M Essock; Melanie M Wall; Lisa B Dixon; Rui Wang; Eric Frimpong; Steven Lamberti; Matthew Schneider; Mark Olfson Journal: Psychiatr Serv Date: 2019-10-08 Impact factor: 3.084
Authors: Agnes Grudniewicz; Allie Peckham; David Rudoler; M Ruth Lavergne; Rachelle Ashcroft; Kimberly Corace; Mark Kaluzienski; Ridhwana Kaoser; Lucie Langford; Rita McCracken; W Craig Norris; Anne O'Riordan; Kevin Patrick; Sandra Peterson; Ellen Randall; Jennifer Rayner; Christian G Schütz; Nadiya Sunderji; Helen Thai; Paul Kurdyak Journal: BMJ Open Date: 2022-09-20 Impact factor: 3.006