Lucy Church Barker1, Andrea Gruneir2,3,4,5, Kinwah Fung2,3, Nathan Herrmann1,6, Paul Kurdyak1,2,4,7, Elizabeth Lin1,2,4,7, Paula A Rochon2,3,4,8, Dallas Seitz9, Valerie H Taylor1,3, Simone N Vigod10,11,12,13. 1. Department of Psychiatry, University of Toronto, Toronto, Canada. 2. Institute for Clinical Evaluative Sciences, Toronto, Canada. 3. Women's College Hospital and Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. 4. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 5. Department of Family Medicine, University of Alberta, Edmonton, Canada. 6. Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada. 7. Centre for Addiction and Mental Health, Toronto, Canada. 8. Department of Medicine, University of Toronto, Toronto, Canada. 9. Department of Psychiatry, Queen's University, Kingston, Canada. 10. Department of Psychiatry, University of Toronto, Toronto, Canada. simone.vigod@wchospital.ca. 11. Institute for Clinical Evaluative Sciences, Toronto, Canada. simone.vigod@wchospital.ca. 12. Women's College Hospital and Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. simone.vigod@wchospital.ca. 13. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. simone.vigod@wchospital.ca.
Abstract
PURPOSE: Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. METHODS: We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among women (n = 33,353) and men (n = 32,436) discharged from all psychiatric units in Ontario, Canada (2008-2011). Predictor variables included sociodemographics, health service utilization, and clinical characteristics. Using derivation data sets, multivariable logistic regression models were fit to determine optimal predictive models for each sex separately. Results were presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). The multivariable models were then applied in the internal validation data sets. RESULTS: The 30-day readmission rates were 9.3% (women) and 9.1% (men). Many predictors were consistent between women and men. For women only, personality disorder (aOR 1.21, 95% CI 1.03-1.42) and positive symptom score (aOR 1.41, 95% CI 1.09-1.82 for score of 1 vs. 0; aOR 1.44, 95% CI 1.26-1.64 for ≥ 2 vs. 0) increased odds of readmission. For men only, self-care problems at admission (aOR 1.20, 95% CI 1.06-1.36) and discharge (aOR 1.44, 95% CI 1.26-1.64 for score of 1 vs. 0; aOR 1.79, 95% CI 1.17-2.74 for 2 vs. 0), and mild anxiety rating (score of 1 vs. 0: aOR 1.30, 95% CI 1.02-1.64, derivation model only) increased odds of readmission. Models had moderate discriminative ability in derivation and internal validation samples for both sexes (c-statistics 0.64-0.65). CONCLUSIONS: Certain key predictors of psychiatric readmission differ by sex. This knowledge may help to reduce psychiatric hospital readmission rates by focusing interventions.
PURPOSE:Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. METHODS: We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among women (n = 33,353) and men (n = 32,436) discharged from all psychiatric units in Ontario, Canada (2008-2011). Predictor variables included sociodemographics, health service utilization, and clinical characteristics. Using derivation data sets, multivariable logistic regression models were fit to determine optimal predictive models for each sex separately. Results were presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). The multivariable models were then applied in the internal validation data sets. RESULTS: The 30-day readmission rates were 9.3% (women) and 9.1% (men). Many predictors were consistent between women and men. For women only, personality disorder (aOR 1.21, 95% CI 1.03-1.42) and positive symptom score (aOR 1.41, 95% CI 1.09-1.82 for score of 1 vs. 0; aOR 1.44, 95% CI 1.26-1.64 for ≥ 2 vs. 0) increased odds of readmission. For men only, self-care problems at admission (aOR 1.20, 95% CI 1.06-1.36) and discharge (aOR 1.44, 95% CI 1.26-1.64 for score of 1 vs. 0; aOR 1.79, 95% CI 1.17-2.74 for 2 vs. 0), and mild anxiety rating (score of 1 vs. 0: aOR 1.30, 95% CI 1.02-1.64, derivation model only) increased odds of readmission. Models had moderate discriminative ability in derivation and internal validation samples for both sexes (c-statistics 0.64-0.65). CONCLUSIONS: Certain key predictors of psychiatric readmission differ by sex. This knowledge may help to reduce psychiatric hospital readmission rates by focusing interventions.
Entities:
Keywords:
Psychiatric epidemiology; Psychiatric readmission; Sex differences; Sex-based analysis
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