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Hospital readmission more likely in patients with serious mental illness

Using 2014 nationwide readmissions data, researchers found that patients with serious mental illnesses were nearly twice as likely to have an unplanned 30-day medical and surgical hospital readmission than those without serious mental illness.

“Risk-adjusted 30-day readmissions are an important indicator of quality care used by the Centers for Medicare & Medicaid Services to guide pay for performance,” Hayley D. Germack, PhD, RN, assistant professor in the School of Nursing, University of Pittsburgh, and colleagues wrote in JAMA Psychiatry. “Research using hospital and state data suggests that medical and surgical readmission rates for patients with [serious mental illness] may be higher than for those without [serious mental illness], but the differences in nationwide estimates of 30-day all-cause readmissions are unknown.”

Researchers calculated and compared all-cause, unplanned, 30-day medical and surgical readmission rates in adult patients with and without serious mental illness admitted from Jan. 1 through Nov. 30, 2014 using the 2014 Nationwide Readmissions Database. To estimate the effect of serious mental illness diagnosis on the risk for hospital readmission within 30 days, they performed logistic regression analysis controlled for demographic, clinical, and hospital characteristics.

The database contained more than 15 million weighted index admissions for medical (1,825,405 weighted readmissions) and surgical (590,121 weighted readmissions) reasons. Germack and colleagues found that the all-cause 30-day medical readmission rate was 23.1% for patients with serious mental illness compared with 13.8% for those without, and the all-cause 30-day surgical readmission rate was 19.3% vs. 9.4%.

After controlling for covariates, analysis revealed that patients with serious mental illness were at greater risk for readmission than those without mental illness for medical (adjusted OR = 1.8; 95% CI, 1.77-1.83) and surgical (adjusted OR = 1.95; 95% CI, 1.9-1.99) reasons.

“These findings suggest that the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program should attend to the population of patients with [serious mental illness] to reduce unplanned readmissions,” Germack and colleagues wrote. “Further research is needed to identify interventions such as transitional care to prevent readmissions for these patients.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.