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Management Strategies To Reduce Psychiatric Readmissions
Technical Briefs, No. 21
Investigators: Bradley N Gaynes, MD, MPH, Carrie Brown, MD, MPH, Linda J Lux, MPA, Mahima Ashok, PhD, Emmanuel Coker-Schwimmer, MPH, Valerie Hoffman, PhD, Brian Sheitman, MD, and Meera Viswanathan, PhD.
Author Information and AffiliationsStructured Abstract
Background:
Repeated psychiatric hospitalizations, affecting primarily those individuals with a serious mental illness, are a substantial problem. Little is known about the effectiveness of different lengths of hospital stay for these patients, transition support services after discharge, short-term alternatives to psychiatric rehospitalization, or long-term approaches for reducing psychiatric rehospitalization.
Purpose:
To describe and compare four core management strategies to reduce psychiatric readmissions—length of stay for inpatient care, transition support services (i.e., care provided as the individual moves to outpatient care), short-term alternatives to psychiatric rehospitalization (i.e., short-term outpatient care provided in place of psychiatric rehospitalization for those not at significant risk of harm to self or others), and long-term approaches for reducing psychiatric rehospitalization—for patients at high risk of psychiatric readmission.
Methods:
We searched published and unpublished sources for information about the effectiveness of these strategies. We also interviewed Key Informants, representing mental health providers, health services researchers, policymakers, payers, and patient advocacy groups, to confirm and augment our findings.
Findings:
Other than Assertive Community Treatment (ACT), a long-term approach for reducing psychiatric rehospitalization, we did not identify an overall theoretical model that identified key intervention components. Components of the various strategies overlap and are likely interdependent. Evidence suggests that the most commonly measured outcome, psychiatric readmissions, probably undercounts true readmission rates; other measures of well-being and functioning need to be measured. Of the 64 studies that assessed the link between a management strategy and readmission, 2 addressed LOS, 5 addressed transition support services, 4 addressed short-term alternatives to psychiatric rehospitalization, and 53 addressed long-term approaches for reducing psychiatric rehospitalization. The bulk of these studies address three interventions: case management, involuntary outpatient commitment/compulsory treatment orders, and ACT. The availability and implementation of the various management strategies can vary substantially across the country.
Conclusions:
Important next steps include determining (1) the key components, or packages of components, that are most effective in keeping those at high risk of psychiatric rehospitalization functioning in the community; (2) how to accurately measure the most meaningful outcomes; and (3) how to most efficiently apply effective strategies to areas with varying resources.
Contents
- Preface
- Acknowledgments
- Key Informants
- Peer Reviewers
- Background
- Findings
- Summary and Implications (GQ 4)
- Next Steps
- 1 Determine the Key Components, or Packages of Components, That Are Most Effective To Keep Those at High Risk of Psychiatric Hospitalization Functioning in the Community as Much as Possible
- 2 Determine How To Accurately Measure the Most Meaningful Outcomes
- 3 Determine How To Most Efficiently Apply Effective Strategies to Areas With Varying Resources
- References
- Appendix A Key Informant Interview and Literature Search Methodology
- Appendix B Literature Strategy and Yields
- Appendix C Excluded Studies
- Appendix D Potentially Relevant Ongoing and Unpublished Studies
- Appendix E Characteristics and Outcomes for Management Strategies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2012-00008-I, Prepared by: RTI–UNC Evidence-based Practice Center, Research Triangle Park, NC
Suggested citation:
Gaynes BN, Brown C, Lux LJ, Ashok M, Coker-Schwimmer E, Hoffman V, Sheitman B, Viswanathan M. Management Strategies To Reduce Psychiatric Readmissions. Technical Brief No. 21. (Prepared by the RTI-UNC Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No.15-EHC018-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the RTI International-University of North Carolina Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00008-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, reimbursement or coverage policies, may not be stated or implied.
None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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