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Factors contributing to readmission in patients with psychotic disorders, with a special reference to first follow-up visit in outpatient care

Published online by Cambridge University Press:  09 May 2024

Kimmo Suokas Open the ORCID record for Kimmo Suokas [Opens in a new window] ,
Maija Lindgren ,
Mika Gissler ,
Emmi Liukko ,
Laura Schildt ,
Raimo K. R. Salokangas ,
Päivi Rissanen ,
Tapio Gauffin ,
Petri Näätänen  and
Minna Holm
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Kimmo Suokas*
Affiliation:
Finnish Psychiatric Association, Helsinki, Finland Faculty of Social Sciences, Tampere University, Tampere, Finland Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Maija Lindgren
Affiliation:
Finnish Institute for Health and Welfare, Equity Unit, Mental Health, Helsinki, Finland
Mika Gissler
Affiliation:
Finnish Institute for Health and Welfare, Information and Guidance of Information Management, Knowledge Brokers, Helsinki, Finland University of Turku, Research Centre for Child Psychiatry and Invest Research Flagship, Turku, Finland Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Region Stockholm; Academic Primary Health Care Centre, Stockholm, Sweden
Emmi Liukko
Affiliation:
Finnish Institute for Health and Welfare, Data and Analytics Unit, Helsinki, Finland
Laura Schildt
Affiliation:
Finnish Institute for Health and Welfare, Data and Analytics Unit, Helsinki, Finland
Raimo K. R. Salokangas
Affiliation:
Department of Psychiatry, University of Turku, Turku, Finland
Päivi Rissanen
Affiliation:
Faculty of Social Sciences, Tampere University, Tampere, Finland The Finnish Central Association for Mental Health, Helsinki, Finland
Tapio Gauffin
Affiliation:
Department of Strategic Services, Wellbeing Services County of Lapland, Rovaniemi, Finland Faculty of Medicine, University of Helsinki, Helsinki, Finland
Petri Näätänen
Affiliation:
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Minna Holm
Affiliation:
Finnish Institute for Health and Welfare, Equity Unit, Mental Health, Helsinki, Finland
Jaana Suvisaari
Affiliation:
Finnish Institute for Health and Welfare, Equity Unit, Mental Health, Helsinki, Finland
*
Corresponding author: Kimmo Suokas; Email: kimmo.suokas@tuni.fi
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Abstract

Background

Timely outpatient follow-up and readmission after discharge are common quality indicators in psychiatric care, but their association varies in previous research. We aimed to examine whether the impact of outpatient follow-up and other factors on readmission risk evolves over time in people with non-affective psychotic disorder (NAP).

Methods

The Finnish Quality of Care Register includes all people diagnosed with NAP since January 2010. Here, we followed patients with a hospital discharge between 2017 and 2021 until readmission, death, or up to 365 days. Time of the first outpatient follow-up appointment, length of stay (LOS), number of previous hospitalizations, psychosis diagnosis, substance use disorder (SUD), residential status, economic activity, gender, age, year, and region were included. Follow-up time was divided into five periods: week 1, weeks 2–4, weeks 5–13, weeks 14–25, and weeks 26–52, and each period was analyzed separately with Cox regression.

Results

Of the 29 858 discharged individuals, 54.1% had an outpatient follow-up within a week. A total of 10 623 (35.6%) individuals were readmitted. Short LOS increased the readmission risk in the first four weeks, whereas lack of outpatient follow-up raised the risk (adjusted HRs between 1.15 (95% CI 1.04–1.26) and 1.53 (1.37–1.71) in weeks 5–52. The number of previous hospitalizations remained a consistent risk factor throughout the follow-up, while SUD increased risk after 4 weeks and living without family after 13 weeks.

Conclusions

Risk factors of readmission vary over time. These temporal patterns must be considered when developing outpatient treatment programs.

Keywords

clinical outcomes measuresinpatient treatmentmental health servicesoutpatient treatmentpsychotic disorders/schizophrenia
Type
Original Article
Information
Psychological Medicine , First View , pp. 1 - 10
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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