Repetitive Hospital Readmission of Psychiatry Patient
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Added on 2020-05-28
Repetitive Hospital Readmission of Psychiatry Patient
Added on 2020-05-28
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Need special attention on – RFPQUESTION:1. What is the state of our knowledge of risk factors (individual, organizational, or system) for readmission? 2. Given the limitations, why is this design appropriate compared to other potential designs? 3. How will these participants be sampled or represented in the study design? Quantitative Research
Table of ContentsExecutive summary................................................................3Introduction.........................................................................4Objecives............................................................................5Methodology.........................................................................5Design and setting...................................................................5Patients...............................................................................5Inclusion criteria...........................................................6 Exclusion criteria..........................................................6Strengths and limitations...........................................................6Strengths.....................................................................6Limitations..................................................................6Rationale for intervention...........................................................6Data collection........................................................................7Dependent variables..................................................................7Independent variables................................................................7 Resources necessary for evaluation of hospital readmissions..................8Implementation strategy.............................................................8Outcomes..............................................................................8Data analysis...........................................................................9References...............................................................................14
Executive summary:Repetitive hospital readmission among psychiatry patients reflects quality of nursing andmedical care received by these patients. Hospital readmissions can be effectively controlledby implementing pre and post discharge treatment. Not only medical treatment but alsopatient related factors are responsible for hospital readmissions. It is evident that rate ofhospital readmissions in Ontario have been high. Hence, it is necessary to reduce rate ofhospital readmissions. In this proposal, parameters required to reduce hospital readmissionswill be evaluated. Identifying these parameters will be helpful in reducing risk of hospitalreadmissions. In this evaluation programme pre-test and post-test study design will beimplemented. In the pre-test baseline characteristics of the patients will be collected and inpost-test impact of the evaluation programme will be evaluated at days 30, 60 and 90.Inclusion and exclusion criteria will be set for the patients to decide eligibility for enrolmentin the programme. Patients will be randomised in control and intervention arm based on thebaseline characteristics. Psychiatric counselling will be provided to intervention arm patientsonly. Environmental factors as the internal validity and population external validity will bestrength of this programme. Maturation and carryover effect as internal validity andecological external validity will be limitations of this evaluation programme. Participants willbe selected from the 15 hospitals. Data from the hospital health information systems and self-reporting by patients will be used for the evaluation of effectiveness of the hospitalreadmission reduction programme. Descriptive statistics will be used for the analysis of thedata. Data for readmissions within 30, 60 and 90 days will be analysed separately.3 | Page
Introduction:Repeated hospitalisation is mainly dependent on the type and severity of psychiatric disorder.Repeated hospitalisation also reflects environmental and social aspects. Along with this, italso reflects deficiencies in pre and post discharge treatment. Readmissions can affect bothpatients and their families and hospitals1. Both patient families and hospital can experiencepsychological strain and financial burden. Hospital readmissions can be prevented byproviding holistic care during the hospital stay, planned discharge and transition and adequatefollow-up. Reduction in the hospital readmissions can be helpful in improving acceptance ofthe psychiatric patient in the society and improving confidence of the patient2. Usually, hospital readmissions within 30 days is considered as poor clinical outcome in caseof psychiatric disorders. This poor outcome might be due to inadequate community-basedcare after discharge, self-care and difficulties in adherence to the psychiatric medication. Ithas been estimated that approximately 9 % patients with principal mood disorders werereadmitted and 12 % patients with any diagnosis of mood disorders were readmitted. It hasbeen estimated that approximately 16 % patients with principal schizophrenia werereadmitted and 19 % patients with any diagnosis of schizophrenia were readmitted. Adequatecare at home can be used as a good indicator for reduced readmission for psychiatricdisorders. However, it has been estimated that only 1 – 6 % patients with mood disorders andschizophrenia receive proper care at home3. Initial cost for the management of psychiatricdisorders is lower as compared to the other conditions. However, readmission cost forpsychiatric disorders is more as compared to other disorders. As compared to otherconditions, patients with psychiatric conditions like mood and schizophrenia are with moredischarge disposition of home-care or self-care. 89 % patients with mood disorders and 78 %patients with schizophrenia are with discharge disposition of home-care or self-care. 62 %patients with other than psychiatric conditions are with discharge disposition of home-care orself-care4.Mood disorder and schizophrenia are the major causes of hospital readmissions along withother causes like alcohol related disorders and substance related disorders. Male patients (14%) are more prone to readmissions as compared to the female patients (12 %). 12.5 %, 14.5% and 12.6 % patients were readmitted between age group 18-44, 45-64 and above 65respectively. Patient level predictors of hospital readmissions can be confounding howeversystem level predictors like capacity, structure or treatment of organisation can be definite4 | Page
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