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Clinical and organizational factors predicting readmission for mental health patients across Italy

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Abstract

Purpose

The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors.

Methods

The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single- and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates.

Results

The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree.

Conclusions

Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.

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Acknowledgements

We wish to thank the staff of “Direzione Generale della Programmazione Sanitaria - Banca Dati SDO” of the Italian Ministry of Health for providing data for this research, the CEPHOS-LINK Group for the definition of the global EU study design, and Dr. Jesse Canchola for his clarifications on the use of coefficient of variation with percentages. This paper used data collected for the CEPHOS-LINK project, which has received funding from the European Union’s Seventh Framework Programme for research, technological development, and demonstration under grant agreement no 603264.

Author information

Correspondence to Federico Tedeschi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study was reviewed and approved by the ethical committee of the Verona University Hospital (N. Prog. 437CESC) and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Tedeschi, F., Donisi, V., Salazzari, D. et al. Clinical and organizational factors predicting readmission for mental health patients across Italy. Soc Psychiatry Psychiatr Epidemiol 55, 187–196 (2020). https://doi.org/10.1007/s00127-019-01766-y

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Keywords

  • Hospital readmission
  • Psychiatric patients
  • Random effects
  • Contextual variation