AHRQ Briefs Probe Issue of Hospital Readmissions for Psychiatric Conditions

Two new briefs from AHRQ examine the issue of readmissions for psychiatric hospitalization. A statistical brief from AHRQ’s Healthcare Cost and Utilization Project found that 30-day readmission rates in 2012 were 15.7 percent when the primary diagnosis was schizophrenia and 9 percent when the primary diagnosis involved mood disorders. This compares with a 30-day readmission rate of 3.8 percent for all other non-mental health/substance abuse conditions. Meanwhile, a technical brief from AHRQ’s Effective Health Care Program found that the availability and implementation of strategies to reduce hospital readmissions for psychiatric conditions vary widely and that these readmissions are probably undercounted. It concluded that more research is needed to determine which strategies work best to reduce readmissions for psychiatric conditions, ways to accurately measure the most meaningful outcomes and the best ways to apply effective strategies in settings with varying resources. In 2012, nearly one quarter of U.S. adults experienced some form of mental or substance use disorder.

May 2015

Hospital Readmissions Involving Psychiatric Disorders, 2012

Kevin C. Heslin, Ph.D. and Audrey J. Weiss, Ph.D.

Introduction

In 2012, nearly one-fourth of adults in the United States experienced some form of mental or substance use disorder (M/SUD).¹ Many patients who experience M/SUDs are hospitalized for those conditions. Between 2003 and 2011, hospitalization for mental disorders increased at a faster rate than for any other type of hospitalization (i.e., medical, surgical, injury, maternal/neonatal).²

Mood disorders and schizophrenia (and other psychotic disorders) were the two most frequent principal diagnoses among hospitalizations involving M/SUD conditions in 2011.³ Among all hospitalizations in 2011, the sixth most common diagnosis was mood disorders, accounting for nearly 900,000 hospital stays.⁴ In addition, mood disorders was the most common reason for hospitalization among children aged 1-17 years.⁵

Mental disorders such as schizophrenia, bipolar disorder, and mood disorders are especially prevalent among Medicare beneficiaries who are under age 65 and eligible for Medicare based on their disability. In 2011, approximately 37 percent of all disabled Medicare beneficiaries had a severe mental disorder.⁶

Hospital readmission within 30 days of discharge usually represents a negative clinical outcome for patients with mental disorders and may be due to factors such as poor access to adequate community-based aftercare and challenges in psychiatric medication adherence and self-care.⁷ In 2011, mood disorders and schizophrenia had the highest number of all-cause 30-day hospital readmissions among adult Medicaid patients, reflecting the chronic, relapsing course of these conditions.⁸

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents data on hospital readmissions for mood disorders and forschizophrenia and other psychotic disorders (hereafter referred to in the text as schizophrenia for brevity). The Brief provides statistics on utilization and costs for hospital inpatient stays for mood disorders and schizophrenia compared with stays for non-M/SUD conditions, along with the rate and cost of readmissions occurring within 30 days of initial hospitalization. The most frequent reasons for 30-day readmission after an initial hospitalization for mood disorders or schizophrenia are also presented. Finally, patient demographic characteristics for readmissions involving mood disorders and schizophrenia are provided. Differences greater than 20 percent between weighted estimates are noted in the text.

Findings

Hospital inpatient stays for mood disorders and schizophrenia, 2012
Table 1 presents utilization and aggregate costs for hospital stays with a principal diagnosis of mood disorders or schizophrenia in 2012. A comparison is provided with all other hospital stays that were unrelated to an M/SUD condition, excluding maternal and neonatal stays.

Highlights

In 2012, there were approximately 847,000 hospital stays for mood disorders and 383,000 stays for schizophrenia.

Within 30 days, 9.0 percent of initial inpatient stays for mood disorders were readmitted with a principal diagnosis of mood disorders, 12.6 percent were readmitted with any diagnosis of mood disorders, and 15.0 percent were readmitted for any cause.

Within 30 days, 15.7 percent of initial inpatient stays for schizophrenia were readmitted with a principal diagnosis of schizophrenia, 18.6 percent were readmitted with any diagnosis of schizophrenia, and 22.4 percent were readmitted for any cause.

Only 1.0-1.6 percent of stays for mood disorders or schizophrenia involved home health care following discharge compared with 14.1 percent of stays for conditions other than mental or substance use disorders (M/SUDs).

Average hospital costs for mood disorders and schizophrenia were lower than average costs for non-M/SUD stays, for the initial stay and for 30-day readmissions.

Compared with initial stays for mood disorders, average hospital costs were higher for readmissions involving mood disorders and for readmissions for any cause ($7,100 and $7,200, respectively, vs. $5,800).

Patients covered by Medicare or Medicaid had higher rates of 30-day readmission involving mood disorders or schizophrenia than did privately insured and uninsured patients (approximately 40-75 percent higher).