Factors Associated With The Psychiatric Hospital Readmission In Beijing,China

[Background]Readmission in psychiatric patients can lead to increased financial burden for the patients as well as the dependence on inpatient services.Psychiatric readmission is also one of the important outcome quality indicators for psychiatric care monitoring.This study aims to identify factors influencing readmission in psychiatric patients,while exploring measures to monitor and improve the mental health care quality in China.[Methods]This study was based on the front page of medical records database of Beijing,China.The 30-day,1-year and 1-year frequent(≥3 times)readmission rates were calculated for eligible patients.The time gaps between admissions were described.Individual and provider-level influencing factors were explored using multi-variate Logistic regression and Cox regression models.[Results]The study included 7724 patients from 3 tertiary and 7 secondary psychiatric hospitals in Beijing.The 30-day and 365-day psychiatric readmission rates were 16.69%and 33.79%respectively.For the patients who had been readmitted within 1 year after the initial discharge,29.34%were readmitted 3 times or more.The factors that were associated with increased readmission risk were residing in urban area,having physical comorbidities,having previous hospitalization(s),with length of stay>60 days and being treated in tertiary hospitals.The study found that the use of electroconvulsive therapy was significantly associated with reduction in the 30-readmission risk(odds ratio 0.72,95%confidence interval 0.56-0.91).According to the sensitivity analysis based on major diagnoses,patients with schizophrenia and related disorders had similar factors influencing readmission risk as the whole sample;whereas in patients with affective disorders,<40 years of age was significantly associated with alleviated risk of 30-day readmission,and although the use of electroconvulsive therapy was associated with the decrease in the 30-readmission risk,the association was not statistically significant.[Conclusion]This study showed that more than 30%of psychiatric patients would be readmitted 1 year after initial discharge,and 10%would be readmitted 3 times or more.Patients residing in the urban area,having comorbidities,having been hospitalized previously,and/or having longer psychiatric length of stay were more likely to be readmitted.This could help identifying the vulnerable population and designing targeted interventions.Future studies can focus on monitoring the psychiatric readmission at the national level.Interventions to reduce readmission on the provider,community and household levels should also be explored,so that the quality and efficiency of psychiatric care in China can be further improved.