Psychiatric Rehospitalization: Development of a XXXX -Level Indicator for Care Planning and Quality Assurance.

@entity1 @entity1032 @entity146 @entity2357 @entity716
OBJECTIVE: Rehospitalization affects quality of life and health system efficiency. Although this outcome is a common quality indicator, there are few applications for linking evaluation to risk mitigation at the @entity1 level. This study examined risk factors for rehospitalization to develop an application for supporting care planning based on the interRAI @entity1032 ( @entity1032 ), a commonly available assessment system. METHOD: A retrospective analysis was performed of 53,538 @entity146 inpatients assessed with the interRAI @entity1032 in Ontario, Canada, between January 2010 and May 2014. The interRAI @entity1032 is a clinical system for assessing demographic variables, service utilization, functional status, and clinical needs. @entity2357 models and survival analysis were used to develop the Rehospitalization Clinical Assessment Protocol by predicting 90-day rehospitalization to any inpatient mental health bed. RESULTS: Variables found to significantly predict rehospitalization included 6 or more lifetime hospitalizations (odds ratio [OR] = 1.40), positive symptoms of @entity716 (OR = 1.23), a secondary substance use disorder (OR = 1.13), and being at risk of harm to self (OR = 1.11). Using these variables, the Rehospitalization Clinical Assessment Protocol was derived whereby those at level 2 (highest) were 74% more likely to be rehospitalized within 90 days than those at level 0. By 1-year postdischarge, 30% at level 2 and 18% at level 0 were rehospitalized. CONCLUSIONS: The Rehospitalization Clinical Assessment Protocol is an application supporting care planning for targeting risk of rehospitalization whenever a @entity1 is assessed with the interRAI @entity1032 . Further exploration is needed to understand how the use of this Clinical Assessment Protocol, service processes, and health system structures further mediate or moderate @entity146 rehospitalization risk.
