Risk Factors Associated With Psychiatric Readmission Kim Lorine, PhD,* Haig Goenjian, MD,† Soeun Kim, PhD,‡ Alan M. Steinberg, PhD,§ Kendall Schmidt, BA,* and Armen K. Goenjian, MD*§ Abstract: The present study focused on identifying risk factors for early read- mission of patients discharged from an urban community hospital. Retrospective chart reviews were conducted on 207 consecutive inpatient psychiatric admis- sions that included patients who were readmitted within 15 days, within 3 to 6 months, and not admitted for at least 12 months post-discharge. Findings indicated that a diagnosis of schizophrenia/schizoaffective disorder (OR = 18; 95% CI 2.70–117.7; p < 0.05), history of alcohol abuse (OR = 9; 95% CI 1.80–40.60; p < 0.05), number of previous psychiatric hospitalizations (OR = 2; 95% CI 1.28–3.73; p < 0.05), and type of residence at initial admission (e.g., homeless, OR = 29; 95% CI 3.99–217; p < 0.05) were significant risk factors for early readmission, where OR compares readmission group 1 versus group 3 in the multinomial logistic regression. Initial positive urine drug screen, history of drug abuse or incarceration, and legal status at initial admission did not pre- dict early readmission. Reducing the risk factors associated with psychiatric readmissions has the potential to lead to the identification and development of preventative intervention strategies that can significantly improve patient safety, quality of care, well-being, and contain health care expenditures. Key Words: Psychiatric readmission, financial burden of readmission, readmission of schizophrenics, readmission of homeless (J Nerv Ment Dis 2015;203: 425–430) I n a study of 249 Florida hospitals of the 10 most common diagnoses that qualified for their criteria of potentially preventable readmis- sions, three were psychiatric diagnoses: schizophrenia was third, major depressive disorder (MDD) was fifth, and bipolar disorder was seventh (Goldfield et al., 2008). According to the 2013 Medicare Payment Advisory Commission Report to Congress (Hackbarth et al., 2013), 15% of Medicare beneficiaries discharged from hospitals in 2011 were readmitted within 30 days. A 2011 report by the Yale New Haven Health Services Corporation/Center for Outcome Research and Evalu- ation report (Horowitz et al., 2011) found that psychiatric readmission rates within 30 days of discharge for fee-for-service (FFS) Medicare beneficiaries 65 and older was 15.8%. In another study among Medi- care beneficiaries, the cost of unplanned re-hospitalizations within 30 days of their discharge was estimated at $17.4 billion in 2004 (Jencks and Williams, 2009). The 30-day re-hospitalization rate for all illnesses was 19.6%, and for “psychosis” (the only psychiatric condition listed) it was 24.6%. Although these studies examined all causes of re- admission, psychiatric readmission comprised a substantial proportion. Numerous studies have examined potential risk factors associ- ated with psychiatric readmission. Some of these studies have been con- ducted in the United States (Jencks and Williams, 2009; Lyons et al., 1997; Olfson et al., 1999; Thompson et al., 2003), whereas other studies were overseas (Bernardo and Forchuk, 2001; Loch, 2012; Silva et al., 2009; Zhang et al., 2011). These studies varied with regard to ethnic/racial mix, socioeconomic status, timing of assessments, and di- agnostic categories evaluated. For example, some studies evaluated general psychiatric populations (Bernardo and Forchuk, 2001; Lyons et al., 1997; Thompson et al., 2003; Zhang et al., 2011), whereas others only evaluated patients with schizophrenia and schizoaffective disorder (SAD) (Fennig and Rabinowitz, 1999; Olfson et al., 1999; Schennach et al., 2012; Suzuki et al., 2003). Also, time of readmission varied across these studies from 30 days (Burke et al., 2013; Lyons et al., 1997), 3 months (Olfson et al., 1999), 6 months (Lyons et al., 1997; Thompson et al., 2003), and 1 year (Loch, 2012; Schennach et al., 2012; Zhang et al., 2011), or longer (Bernardo and Forchuk, 2001; Rosca et al., 2006). Even though these variations make generalizations across studies problematic, there are commonalities in many of the studies that may serve as guidelines to improve delivery of health care to severely ill psychiatric patients. Risk factors identified in studies among general psychiatric pop- ulations have included a diagnosis of schizophrenia (Rosca et al., 2006; Silva et al., 2009) and SAD (Thompson et al., 2003), presence of more severe symptoms and greater impairment in self-care (Lyons et al., 1997), younger age at first admission (Silva et al., 2009), use of restraints while hospitalized (Loch, 2012), number of previous ad- missions (Haywood et al., 1995; Silva et al., 2009; Zhang et al., 2011), alcohol intoxication, and posing a danger to others at the time of the initial admission (Zhang et al., 2011). In studies which included only patients with schizophrenia, risk for readmission included number of previous admissions (Olfson et al., 1999; Schennach et al., 2012), co- morbid substance abuse (Olfson et al., 1999), medication noncompli- ance after discharge (Bernardo and Forchuk, 2001), not being in remission at time of discharge (Schennach et al., 2012), and noncompli- ance with outpatient clinic visits (Suzuki et al., 2003). The present study examined the association of sociodemographic, clinical, and post-discharge factors with readmission of psychiatric pa- tients discharged from a general hospital located in an urban area of Los Angeles County. The objective was to identify risk factors associ- ated with readmission within 15 days and within 3 to 9 months. METHODS Participants For the present study, retrospective chart reviews were performed on 207 psychiatric inpatients from an urban community hospital. Pa- tients were hospitalized for acute psychiatric illnesses. These patients were referred from local county and private emergency rooms, board and care facilities, residential facilities, mental health clinics, police, and private practitioners. Chart reviews were conducted on consecutive readmissions that fit in three time parameters: readmitted within 15 days (group 1, N = 62), readmitted within 3 to 6 months (group 2, N = 86), and not readmitted for at least 12 months post-discharge (group 3, N = 59). Patients within each group were independent and did not over- lap (i.e., patients in group 1 were not included in groups 2 or 3). The ad- missions covered the period January through December 2010. Upon initial hospitalization, patients were stabilized (at a mini- mum, they no longer constituted a danger to themselves/others and *Collaborative Neuroscience Network, LLC, Garden Grove; †Harbor UCLA Medical Center, Torrance, CA; ‡University of Texas Health Science Center, Division of Biostatistics, Houston, TX; and §UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA. Send reprint requests to Armen K. Goenjian, MD, UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, 11150 W Olympic Blvd, Suite 650, Los Angeles, CA 90064. E-mail: agoenjia@g.ucla.edu. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0022-3018/15/20306–0425 DOI: 10.1097/NMD.0000000000000305 ORIGINAL ARTICLE The Journal of Nervous and Mental Disease • Volume 203, Number 6, June 2015 www.jonmd.com 425 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.