Impact of Clubhouses in Reducing Psychiatric Readmission Risk

Introduction Individuals with severe mental illness (SMI) have complex needs that can contribute to repeated psychiatric admissions if not addressed adequately. Interventions that can reduce psychiatric recidivism are an area of interest and focus given the high readmission rates for this population. A clubhouse is a community-based service dedicated to supporting and empowering people living with mental illness. While there have been studies on the rehabilitative and recovery aspects of clubhouse participation, limited research has focused on its direct impact on clinical outcomes, particularly in reducing psychiatric readmission rates. Objective The period following discharge from a psychiatric hospital is considered a "risk period" for readmission. For the purpose of this study, the risk period is defined as 90 days following a discharge from a psychiatric hospital. As part of this retrospective study, we identified "at-risk" individuals with a recent psychiatric admission, who started clubhouse during that period. We hypothesized that clubhouse participation during the high-risk post-discharge period would be associated with a statistically significant reduction in 90-day psychiatric readmission rates compared to pre-enrollment hospitalization rates. The objective of the study was to identify if clubhouse participation resulted in a reduction in hospital readmission as compared to the general 90-day readmission risk in SMI individuals during the risk period. Methodology The Detroit Wayne Integrated Health Network (DWIHN), a Prepaid Inpatient Health Plan (PIHP), provided claims data for clubhouse participation and inpatient psychiatric admissions. Clubhouse members were narrowed to include a subgroup that had at least one psychiatric admission in 90 days before starting clubhouse. Their psychiatric readmission rates were assessed for the 90 days after starting clubhouse. Statistical significance was established at 0.05, and a two-tailed t-test was performed to determine if the reduction in psychiatric admissions was related to clubhouse participation. Ninety-day readmission rates were calculated for clubhouse members and compared to general DWIHN 90-day readmission rates. Results An eightfold reduction in rehospitalization was noted in the subsequent 90 days for members who started and engaged in clubhouse during the risk period. When compared to DWIHN's general population, this was approximately a 50% lower rate of 90-day hospital readmission rate. Conclusion Clubhouses have an effective role not only in rehabilitation but also in reducing psychiatric readmissions during the high-risk period.