The usefulness of readmission as an outcome indicator and hospital processes to reduce the risk of readmission

[Truncated abstract] To ensure the provision of high quality mental health care, the performance of service providers requires continual assessment. Readmission to psychiatric hospital is one commonly used indicator used to assess inadequate psychiatric care (e.g., NMHWG Information Strategy Committee Performance Indicator Drafting Group, 2004). Nevertheless, the value of readmission as an outcome indicator is questionable, as it is unclear from the existing literature whether readmission clearly reflects a hospital’s poor performance (Lyons et al., 1997). There is also limited evidence available to guide improvements in hospital practice during a psychiatric admission to reduce the risk of subsequent readmission. Accordingly, this thesis aims to clarify the usefulness of readmission as an indicator of earlier inpatient psychiatric care and contribute to the current evidence regarding quality improvement initiatives to reduce readmission. To clarify the usefulness of readmission as an outcome indicator, Section One of this thesis examined the effect of not differentiating between unplanned and planned readmissions on readmission as a quality indicator and re-examined the relationship between the quality of an admission (as indicated by symptom improvement during the index admission) and readmission while accounting for planned readmissions, sample characteristics and length of follow-up. Cautious support for the use of readmission as an outcome indicator was provided as patients with less symptom improvement during the index admission evidenced more subsequent readmissions, although it appeared this relationship may be masked by the characteristics of the sample and the measure of symptom improvement. Including planned readmissions in analyses did not appear to mask the relationship between symptom improvement and readmission although it did lead to overestimations of negative outcomes.