Does the Hospital Predict Readmission? A Multi-level Survival Analysis Approach

Adm Policy Ment Health. 2016 Jul;43(4):514-23. doi: 10.1007/s10488-015-0654-9.

Abstract

Time to psychiatric rehospitalization was predicted for a sample of 1473 Medicaid-insured youth in Illinois in 2005 and 2006. A multi-level model statistical strategy was employed to account for the fact that youth days to rehospitalization were nested within hospital and to test the hypothesis that hospitals would vary significantly in return rates, controlling for individual-level (e.g., symptom, demographic) variables. Hospitals did not vary significantly in days to rehospitalization. At the individual-level, level of externalizing behavior and residential treatment placement predicted a faster return to the hospital. These results support the perspective that hospital outcomes are best operationalized using variables tied more directly to the inpatient episode (e.g., LOS, reductions in acuity).

Keywords: Inpatient psychiatric care; Multilevel survival analysis; Psychiatric readmission; Psychiatric rehospitalization.

MeSH terms

  • Adolescent
  • Anxiety / epidemiology
  • Anxiety / therapy
  • Attention Deficit and Disruptive Behavior Disorders / epidemiology
  • Attention Deficit and Disruptive Behavior Disorders / therapy
  • Child
  • Child, Preschool
  • Conduct Disorder / epidemiology
  • Conduct Disorder / therapy
  • Depression / epidemiology
  • Depression / therapy
  • Female
  • Hospitals, Psychiatric / statistics & numerical data*
  • Humans
  • Impulsive Behavior
  • Length of Stay / statistics & numerical data*
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / therapy*
  • Multilevel Analysis
  • Patient Readmission / statistics & numerical data*
  • Quality Indicators, Health Care
  • Residential Treatment / statistics & numerical data
  • Risk Factors
  • Self Mutilation / epidemiology
  • Self Mutilation / therapy
  • Severity of Illness Index
  • Survival Analysis
  • Time Factors
  • Young Adult