- Management Strategies to Reduce Psychiatric Readmissions: Technical Brief
- 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, or short- or long-term alternatives to psychiatric hospitalization. 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 hospitalizations (i.e., short-term outpatient care provided in place of psychiatric hospitalization for those not at significant risk of harm to self or others), and long-term alternatives to psychiatric hospitalization—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 Methods: We searched published and unpublished sources for information about the effectiveness of these strategies.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), an alternative to psychiatric hospitalization, 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 63 studies that assessed the link between a management strategy and readmission, two addressed LOS, five addressed transition support services, four addressed short-term alternatives to psychiatric hospitalization, and 52 addressed long-term alternatives to psychiatric hospitalization. The bulk of these studies address two interventions: intensive case management (a transitional support service) 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.
- Authors of Report
- Methodology description
- Published Literature Search: An experienced research librarian developed our search strategy (Appendix B). Given that contemporary resources, finances, and needs relevant to psychiatric hospitalization have changed substantially from approximately 25 years ago, we systematically searched the published literature from January 1, 1990, through June 23, 2014. We searched in PubMed (MEDLINE), PsycINFO, and the Cochrane Library. We reviewed the reference lists of relevant papers, and we examined any literature suggested by KIs. We will update the literature review by repeating our searches concurrent with the peer-review process. Gray Literature Search: We searched the gray literature to identify information beyond the published literature on management strategies to reduce psychiatric readmissions. Sources for the gray literature included the following: HAPI, OpenSIGLE, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Academic Search Complete, NIH RePORTER, and ERIC. We also searched Web sites of the relevant professional associations such as the American Psychiatric Association, the National Alliance on Mental Illness, the National Association of Psychiatric Health Systems, and the National Institute of Mental Health. Appendix A provides a brief description of each of these gray literature sources.
- The systematic review data of this published Technical Brief was retrospectively imported into SRDR by the RTI-UNC EPC for the Agency for Healthcare Research and Quality (AHRQ).
The contents of the uploaded files include:
1) Psych Discharge SRDR Design tab_7 16 15_final_v.2 - Study designs, sample sizes, lengths of follow-up, settings, and countries in which included studies were conducted
2) Psych Discharge SRDR Arm Details tab_7 16 15_final_v.2 - Descriptions of management strategy types evaluated in each study, and intervention and comparator arms
3) Psych Discharge SRDR Outcome Details tab_7 16 15_final_v.2 - Hospital readmission outcomes reported, and qualitative summaries of each study's findings
- Funding Source
- The Agency for Healthcare Research and Quality (AHRQ)