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Does the Hospital Predict Readmission? A Multi-level Survival Analysis Approach
Scott C Leon1, Alison M Stoner2, Daniel A Dickson2
1Department of Psychology, Loyola University Chicago, 1032 West Sheridan Road, Coffey Hall, 203, Chicago, IL, 60626, USA. sleon@luc.edu.
Administration and Policy in Mental Health
|May 1, 2015
Summary
Psychiatric rehospitalization rates for youth were analyzed. Externalizing behaviors and residential treatment predicted faster returns, not hospital variations, suggesting outcome measures should focus on inpatient episodes.
Area of Science:
- Psychiatry
- Health Services Research
- Biostatistics
Background:
- Understanding factors influencing psychiatric rehospitalization in youth is crucial for improving care.
- Medicaid-insured youth represent a significant population with unique healthcare needs.
- Previous research has explored individual and systemic factors affecting readmission rates.
Purpose of the Study:
- To predict time to psychiatric rehospitalization for Medicaid-insured youth.
- To investigate whether psychiatric hospitals vary significantly in youth rehospitalization rates.
- To identify individual-level predictors of faster rehospitalization.
Main Methods:
- A multi-level model was used to analyze data from 1473 Medicaid-insured youth in Illinois (2005-2006).
- The model accounted for the nested structure of rehospitalization days within hospitals.
- Individual-level variables (symptoms, demographics) and hospital-level factors were controlled.
Main Results:
- Hospitals did not show significant variation in youth rehospitalization rates.
- Higher levels of externalizing behavior predicted a faster return to psychiatric hospitalization.
- Placement in residential treatment also predicted a faster rehospitalization rate.
Conclusions:
- Hospital-level variations are not significant predictors of psychiatric rehospitalization time for this population.
- Individual-level factors, specifically externalizing behaviors and residential placement, are key predictors.
- Hospital outcome measures should prioritize inpatient episode-specific variables like length of stay and acuity reduction.
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