Predicting rehospitalization and outpatient services from administration and clinical databases

  • Michael S. Hendryx
  • Joan E. Russo
  • Bruce Stegner
  • Dennis G. Dyck
  • Richard K. Ries
  • Peter Roy-Byrne
Brief Reports


The study tests whether psychiatric services utilization may be predicted from administrative databases without clinical variables equally as well as from databases with clinical variables. Persons with a psychiatric hospitalization at an urban medical center were followed for 1 year postdischarge (N=1384.) Dependent variables included statewide rehospitalization and the number of hours of outpatient services received. Three linear and logistic regression models were developed and cross-validated: a basic model with limited administrative independent variables, an intermediate model with diagnostic and limited clinical indicators, and a full model containing additional clinical predictors. For rehospitalization, the clinical cross-validated model accounted for twice the variance accounted by the basic model (adjusted R2=.13 and .06, respectively). For outpatient hours, the basic cross-validated model performed as well as the clinical model (adjusted R2=.36 and .34, respectively.) Clinical indicators such as assessment of functioning and co-occurring substance use disorder should be considered for inclusion in predicting rehospitalization.


Logistic Regression Model Health Promotion Disease Prevention Medical Center Full Model 
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  1. 1.
    Mazade MA, Lutterman T, Glover R. State mental health agency performance measure initiatives in the public mental health system. Center for Mental Health Services. In: Mandersheid RW, Henderson MJ, eds.Mental Health, United States, 1998. Washington, DC: Supt. of Docs., US Government Printing Office; 1998:52–59. DHHS Publication No. (SMA)99-3285.Google Scholar
  2. 2.
    Teague GB, Ganju V, Hornik JA, et al. The MHSIP mental health report card.Evaluation Review. 1997;21:330–341.Google Scholar
  3. 3.
    Banks SM, Pandiani JA, Schacht L, et al. A risk-adjusted measure of hospitalization rates for evaluating community mental health program performance.Administration and Policy in Mental Health. 1999;26:269–279.Google Scholar
  4. 4.
    Hornbrook MC, Goodman MJ. Assessing relative health plan risk with the RAND-36 health survey.Inquiry. 1995;32:56–74.Google Scholar
  5. 5.
    Fowles JB, Weiner JP, Knutson D, et al. Taking health status into account when setting capitation rates.JAMA. 1996;276:1316–1321.Google Scholar
  6. 6.
    Lee C, Rogal D.Risk Adjustment: A Key to Changing Incentives in the Health Insurance Market. Alpha Center; Washington DC March 1997.Google Scholar
  7. 7.
    Weiner JP, Dobson A, Maxwell SL, et al. Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses.Health Care Financing Review. 1996;17(3):77–99.Google Scholar
  8. 8.
    Newhouse JP, Manning WG, Keeler EB, et al. Adjusting capitation rates using objective health measures and prior utilization.Health Care Financing Review. 1989;10:41–54.Google Scholar
  9. 9.
    Ettner SL, Frank RG.Risk Adjustment for Mental Health and Substance Abuse. Center for Mental Health Service, Substance Abuse and Mental Health Services Administration; Washington DC January 1999.Google Scholar
  10. 10.
    Kapur K, Young AS, Murata D. Risk adjustment for high utilizers of public mental health care.The Journal of Mental Health Policy and Economics. 2000;3:129–137.Google Scholar
  11. 11.
    Vogel S, Huguelet P. Factors associated with multiple admissions to a public psychiatric hospital.Acta Psychiatrica Scandinavica. 1997;95:244–253.Google Scholar
  12. 12.
    Doering S, Muller E, Kopcke W, et al. Predictors of relapse and rehospitalization in schizophrenia and schizoaffective disorder.Schizophrenia Bulletin. 1998;24:87–98.Google Scholar
  13. 13.
    Mercer GT, Molinari V, Kunik ME, et al. Rehospitalization of older psychiatric inpatients: an investigation of predictors.Gerontologist. 1999;39:591–598.Google Scholar
  14. 14.
    Olfson M, Mechanic D, Boyer CA, et al. Assessing clinical predictions of early rehospitalization in schizophrenia.Journal of Nervous and Mental Disease. 1999;187:721–729.Google Scholar
  15. 15.
    Perlick DA, Rosenheck RA, Clarkin JF, et al. Symptoms predicting inpatient service use among patients with bipolar affective disorder.Psychiatric Services. 1999;50:806–812.Google Scholar
  16. 16.
    Rabinowitz J, Lichtenberg P, Kaplan Z, et al. Rehospitalization rates of chronically ill schizophrenic patients discharged on a regimen of risperadone, olanzapine, or conventional antipsychotics.American Journal of Psychiatry. 2001;158:266–269.Google Scholar
  17. 17.
    Russo J, Roy-Byrne P, Jaffe C, et al. Psychiatric status, quality of life, and levels of care as predictors of outcomes of acute inpatient treatment.Psychiatric Services. 1997;48:1427–1434.Google Scholar
  18. 18.
    Hollingsworth EJ, Sweeney JK. Mental health expenditures for services for people with severe mental illnesses.Psychiatric Services. 1997;48:485–490.Google Scholar
  19. 19.
    Larson MJ, Farrelly MC, Hodgkin D, et al. Payments and use of services for mental health, alcohol, and other drug abuse disorders: estimates from Medicare, Medicaid, and Private Health Plans. Center for Mental Health Services. In: Mandersheid RW, Henderson MJ, eds.Mental Health, United States, 1998. Washington, DC: Supt. of Docs., US Government Printing Office; 1998:124–141. DHHS Publication No. (SMA)99-3285.Google Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2003

Authors and Affiliations

  • Michael S. Hendryx
    • 1
  • Joan E. Russo
    • 2
    • 3
  • Bruce Stegner
    • 1
    • 4
  • Dennis G. Dyck
    • 1
  • Richard K. Ries
    • 2
    • 5
  • Peter Roy-Byrne
    • 2
    • 3
  1. 1.Washington Institute for Mental Illness Research and TrainingWashington State UniversitySpokane
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattle
  3. 3.Outcomes Assessment and Quality AssuranceHarborview Medical CenterSeattle
  4. 4.Mental Health Division in Department of Social and Health ServicesOlympia
  5. 5.Outpatient Psychiatry and Addiction ServicesHarborview Medical CenterSeattle

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