Skip to main content

Hospital Readmission Among Medicaid Patients with an Index Hospitalization for Mental and/or Substance Use Disorder

The Journal of Behavioral Health Services & Research volume 40, pages 207–221 (2013)Cite this article

An Erratum to this article was published on 23 March 2013

Abstract

Hospital readmission rates are increasingly used as a performance indicator. Whether they are a valid, reliable, and actionable measure for behavioral health is unknown. Using the MarketScan Multistate Medicaid Claims Database, this study examined hospital- and patient-level predictors of behavioral health readmission rates. Among hospitals with at least 25 annual admissions, the median behavioral health readmission rate was 11% (10th percentile, 3%; 90th percentile, 18%). Increased follow-up at community mental health centers was associated with lower probabilities of readmission, although follow-up with other types of providers was not significantly associated with hospital readmissions. Hospital average length of stay was positively associated with lower readmission rates; however, the effect size was small. Patients with a prior inpatient stay, a substance use disorder, psychotic illness, and medical comorbidities were more likely to be readmitted. Additional research is needed to further understand how the provision of inpatient services and post-discharge follow-up influence readmissions.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1

References

  1. Jiang HJ. Hospital readmissions for Medicaid patients: an analysis using multistate databases. Poster presented at: The annual conference of the Agency for Healthcare Research and Quality; September 27–29, 2010; Bethesda, MD.

  2. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine. 2009;360(14):1418–1428.

    PubMed  Article  CAS  Google Scholar 

  3. H.R. 3590 (111th Congress). Patient Protection and Affordable Care Act. 2009. In: GovTrack.us (database of federal legislation). Available at: http://www.govtrack.us/congress/bill.xpd?bill=h111-3590&tab=reports. Accessed June 1, 2012.

  4. Steffen, S., M. Kösters, T. Becker, et al. Discharge planning in mental health care: a systematic review of the recent literature. Acta Psychiatrica Scandinavica. 2009;120(1):1–9.

    PubMed  Article  CAS  Google Scholar 

  5. Nelson E, Maruish M, Axler J. Effects of discharge planning and compliance with outpatient appointments on readmission rates. Psychiatric Services. 2000;51(7):885–889.

    PubMed  Article  CAS  Google Scholar 

  6. Prince JD. Practices preventing rehospitalization of individuals with schizophrenia. Journal of Nervous and Mental Disease. 2006;194(6):397–403.

    PubMed  Article  Google Scholar 

  7. Ilgen MA, Hu KU, Moos RH, et al. Continuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders. Psychiatric Services. 2008;59(9):982–988.

    PubMed  Article  Google Scholar 

  8. Huff ED. Outpatient utilization patterns and quality outcomes after first acute episode of mental health hospitalization. Evaluation & the Health Professions. 2000;23(4):441–456.

    Article  CAS  Google Scholar 

  9. Silow-Carroll S, Edwards JN, Lashbrook A. Reducing hospital readmissions: lessons from top-performing hospitals. Synthesis report. The Commonwealth Fund. 2011;1473(5):1–20.

    Google Scholar 

  10. Mark T, Vandivort-Warren R, Montejano L. Factors affecting detoxification readmission: analysis of public sector data from three states. Journal of Substance Abuse Treatment. 2006;31(4):439–445.

    PubMed  Article  Google Scholar 

  11. Peterson K, Swindle R, Phibbs C, et al. Determinants of readmission following inpatient substance abuse treatment: a national study of VA programs. Medical Care. 1994;32(6):535–550.

    PubMed  Article  CAS  Google Scholar 

  12. Raven M, Carrier E, Lee J, et al. Substance use treatment barriers for patients with frequent hospital admissions. Journal of Substance Abuse Treatment. 2010;38(1):22–30.

    PubMed  Article  Google Scholar 

  13. Kim HM, Pfeiffer, P, Ganoczy D, et al. Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression. Psychiatric Services 2011;62:1346–1352.

    PubMed  Article  Google Scholar 

  14. U.S. Department of Health and Human Services. Significance testing, interval estimates, and comparing rates among hospitals. Available at: http://www.hospitalcompare.hhs.gov/staticpages/for-professionals/ooc/testing-and-interval-estimates.aspx. Accessed May 7, 2012.

  15. Durbin J, Lin E, Layne C, et al. Is readmission a valid indicator of the quality of inpatient psychiatric care. Journal of Behavioral Health Services and Research. 2007;34(2):137–150.

    PubMed  Article  Google Scholar 

  16. Bao Y, Sturm R. How do trends for behavioral health inpatient care differ from medical inpatient care in U.S. community hospitals? Journal of Mental Health Policy and Economics. 2001;4(2):55–63.

    PubMed  Google Scholar 

  17. Wickizer TM, Lessler D, Boyd-Wickizer J. Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents. American Journal of Public Health. 1999;89(9):1353–1358.

    PubMed  Article  CAS  Google Scholar 

  18. Monnelly EP. Instability before discharge and previous psychiatric admissions as predictors of early readmission. Psychiatric Services. 1997;48(12):1584–1586.

    PubMed  CAS  Google Scholar 

  19. Heeren O, Dixon L, Gavirneni S, et al. The association between decreasing length of stay and readmission rate on a psychogeriatric unit. Psychiatric Services. 2002;53(1):76–79.

    PubMed  Article  Google Scholar 

  20. Figueroa R, Harman J, Engberg J. Use of claims data to examine the impact of length of inpatient psychiatric stay on readmission rate. Psychiatric Services. 2004;55(5):560–565.

    PubMed  Article  Google Scholar 

  21. Lyons J, O'Mahoney M, Miller S, et al. Predicting readmission to the psychiatric hospital in a managed care environment: implications for quality indicators. American Journal of Psychiatry. 1997;154(3):337–340.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Minya Sheng of Thomson Reuters for programming and reviewing the data, Sasha Frankel for help formatting and checking results, and Linda Lee, Ph.D., for editorial review. This research was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). The views expressed do not necessarily reflect those of SAMHSA or the Department of Health and Human Services.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Affiliations

  1. Truven Health Analytics, 7700 Old Georgetown Road, Ste GSO, Bethesda, MD, 20814, USA

    Tami Mark PhD, MBA, Niranjana Kowlessar PhD & Bong Chul Chu PhD

  2. Oxford PharmaGenesis, Newtown, PA, 18940, USA

    Karen Smoyer Tomic PhD

  3. Health Resources and Services Administration, Rockville, MD, USA

    Rita Vandivort-Warren MSW

  4. Substance Abuse and Mental Health Services Administration, Rockville, MD, USA

    Shelagh Smith MPH, CHES

  5. Behavioral Health and Quality Research, Truven Health Analytics, Washington, DC, 20008, USA

    Tami Mark PhD, MBA

Authors
  1. Tami Mark PhD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen Smoyer Tomic PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Niranjana Kowlessar PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bong Chul Chu PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rita Vandivort-Warren MSW
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shelagh Smith MPH, CHES
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tami Mark PhD, MBA.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mark, T., Tomic, K.S., Kowlessar, N. et al. Hospital Readmission Among Medicaid Patients with an Index Hospitalization for Mental and/or Substance Use Disorder. J Behav Health Serv Res 40, 207–221 (2013). https://doi.org/10.1007/s11414-013-9323-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-013-9323-5

Keywords

  • Behavioral Health
  • Readmission Rate
  • Hospital Readmission
  • Community Mental Health Center
  • Index Admission