Predicting Patients' Readmission: Do Clinicians Outperform a Statistical Model? An Exploratory Study on Clinical Risk Judgment in Mental Health.
Adolescent
Adult
Aftercare
/ statistics & numerical data
Aged
Female
Hospitalization
/ statistics & numerical data
Humans
Italy
Male
Mental Disorders
/ therapy
Middle Aged
Models, Statistical
Patient Discharge
/ statistics & numerical data
Patient Readmission
/ statistics & numerical data
Prognosis
Psychiatric Department, Hospital
Risk Adjustment
Time Factors
Young Adult
Journal
The Journal of nervous and mental disease
ISSN: 1539-736X
Titre abrégé: J Nerv Ment Dis
Pays: United States
ID NLM: 0375402
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
pubmed:
25
1
2020
medline:
26
3
2021
entrez:
25
1
2020
Statut:
ppublish
Résumé
This study explores whether clinicians or a statistical model can better identify patients at risk of early readmission and investigates variables potentially associated with clinicians' risk judgment. We focus on a total of 142 patients discharged from acute psychiatric wards in the Verona Mental Health Department (Italy). Psychiatrists assessed patients' risk of readmission at 30 and 90 days postdischarge, predicted their postdischarge compliance, and assessed their Global Assessment of Functioning (GAF) score at admission and discharge. Clinicians' judgment outperformed the statistical model, with the difference reaching statistical significance for 30-day readmission. Clinicians' readmission risk judgment, both for 30 and 90 days, was found to be statistically associated with predicted compliance with community treatment and GAF score at discharge. Clinicians' superior performance might be explained by their risk judgment depending on nonmeasurable factors, such as experience and intuition. Patients with a poorer GAF score at discharge and poor assumed compliance were predicted to have a higher risk of readmission.
Identifiants
pubmed: 31977720
doi: 10.1097/NMD.0000000000001140
pii: 00005053-202005000-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
353-361Références
Ådnanes M, Melby L, Cresswell-Smith J, Westerlund H, Rabbi L, Dernovšek MZ, Šprah L, Sfetcu R, Straßmayr C, Donisi V (2018) Mental health service users' experiences of psychiatric re-hospitalisation—An explorative focus group study in six European countries. BMC Health Serv Res. 18:516.
Akaike H (1974) A new look at the statistical model identification. IEEE Transactions on Automatic Control. 19:716–723.
Amaddeo F, Barbui C, Tansella M (2012) State of psychiatry in Italy 35 years after psychiatric reform. A critical appraisal of national and local data. Int Rev Psychiatry. 24:314–320.
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). Available at: https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890420249.dsm-iv-tr. Accessed March 31, 2019.
Atakan Z, Cliff G, Cooper JE (1990) Can psychiatrists predict the one-year outcome of schizophrenia? Soc Psychiatry Psychiatr Epidemiol. 25:117–124.
Baeza FLC, da Rocha NS, Fleck MP de A (2018) Readmission in psychiatry inpatients within a year of discharge: The role of symptoms at discharge and post-discharge care in a Brazilian sample. Gen Hosp Psychiatry. 51:63–70.
Baez-Revueltas FB (2009) Residual Logistic Regression. Available at: https://ir.stonybrook.edu/xmlui/handle/11401/72390. Accessed March 31, 2019.
Becker S, Ichino A (2002) Estimation of average treatment effects based on propensity scores. Stata Journal. 2:358–377.
Bernet AC (2013) Predictors of psychiatric readmission among veterans at high risk of suicide: The impact of post-discharge aftercare. Arch Psychiatr Nurs. 27:260–261.
Bhugra D, Easter A, Mallaris Y, Gupta S (2011) Clinical decision making in psychiatry by psychiatrists. Acta Psychiatr Scand. 124:403–411.
Botha UA, Koen L, Joska JA, Parker JS, Horn N, Hering LM, Oosthuizen PP (2010) The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Soc Psychiatry Psychiatr Epidemiol. 45:461–468.
Bowersox NW, Saunders SM, Berger BD (2012) Predictors of rehospitalization in high-utilizing patients in the VA psychiatric medical system. Psychiatry Q. 83:53–64.
Burgard S, Ailshire JA, Hughes NM (2010) Gender and sleep duration among American adults. Ann Arbor, MI: Population Studies Center, University of Michigan.
Byrne SL, Hooke GR, Page AC (2010) Readmission: A useful indicator of the quality of inpatient psychiatric care. J Affect Disord. 126:206–213.
Cheng KD, Huang CJ, Tsang HY, Lin CH (2014) Factors related to missed first appointments after discharge among patients with schizophrenia in Taiwan. J Formos Med Assoc. 113:436–441.
Daniels BA, Kirkby KC, Hay DA, Mowry BJ, Jones IH (1998) Predictability of rehospitalisation over 5 years for schizophrenia, bipolar disorder and depression. Aust N Z J Psychiatry. 32:281–286.
Dawes RM, Faust D, Meehl PE (1989) Clinical versus actuarial judgment. Science. 243:1668–1674.
Ding P, Miratrix LW (2014) To adjust or not to adjust? Sensitivity Analysis of M-Bias and Butterfly-Bias. J Causal Inference. 3:41–57.
Dixon M, Robertson E, George M, Oyebode F (1997) Risk factors for acute psychiatric readmission. Psychiatric Bulletin. 21:600–603.
Donisi V, Tedeschi F, Salazzari D, Amaddeo F (2016a) Pre- and post-discharge factors influencing early readmission to acute psychiatric wards: Implications for quality-of-care indicators in psychiatry. Gen Hosp Psychiatry. 39:53–58.
Donisi V, Tedeschi F, Wahlbeck K, Haaramo P, Amaddeo F (2016b) Pre-discharge factors predicting readmissions of psychiatric patients: A systematic review of the literature. BMC Psychiatry. 16:449.
Durbin J, Lin E, Layne C, Teed M (2007) Is readmission a valid indicator of the quality of inpatient psychiatric care? J Behav Health Serv Res. 34:137–150.
Fischer C, Lingsma HF, Marang-van de Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW (2014) Is the readmission rate a valid quality indicator? A review of the evidence. PLoS One. 9:e112282.
Frölich M (2007) Propensity score matching without conditional independence assumption—With an application to the gender wage gap in the United Kingdom. Econom J. 10:359–407.
Furnival GM, Wilson RW (1974) Regressions by leaps and bounds. Dent Tech. 16:499–511.
Fusar-Poli P, Hijazi Z, Stahl D, Steyerberg EW (2018) The science of prognosis in psychiatry: A review. JAMA Psychiat. 75:1289–1297.
Glette MK, Kringeland T, Røise O, Wiig S (2018) Exploring physicians' decision-making in hospital readmission processes—A comparative case study. BMC Health Serv Res. 18:725.
Gordon M, Darbyshire D, Baker P (2012) Non-technical skills training to enhance patient safety: A systematic review. Med Educ. 46:1042–1054.
Greenacre M, Blasius J, Blasius J (2006) Multiple correspondence analysis and related methods. London: Chapman and Hall/CRC.
Greenland S (2003) Quantifying biases in causal models: Classical confounding vs collider-stratification bias. Epidemiology. 14:300–306.
Greiner DJ, Rubin DB (2010) Causal effects of perceived immutable characteristics. Rev Econ Stat. 93:775–785.
Grove WM, Zald DH, Lebow BS, Snitz BE, Nelson C (2000) Clinical versus mechanical prediction: A meta-analysis. Psychol Assess. 12:19–30.
Guardabascio B, Ventura M (2013) Estimating the Dose-Response Function through the GLM Approach (German Stata Users' Group Meetings 2013). Stata Users Group. Available at: https://econpapers.repec.org/paper/bocdsug13/10.htm.
Hirano K, Imbens G (2004) The propensity score with continuous treatments. In Gelman A, Meng XL (Eds), Applied Bayesian modeling and causal inference from incomplete-data perspectives (pp 73–84). New York: Wileys.
Hosmer DW, Lemeshow S (2000) Applied logistic regression: Hosmer/applied logistic regression. Hoboken, NJ: John Wiley & Sons, Inc.
Kalseth J, Lassemo E, Wahlbeck K, Haaramo P, Magnussen J (2016) Psychiatric readmissions and their association with environmental and health system characteristics: A systematic review of the literature. BMC Psychiatry. 16:376.
Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M, Kripalani S (2011) Risk prediction models for hospital readmission: A systematic review. JAMA. 306:1688–1698.
Kapur S, Phillips AG, Insel TR (2012) Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol Psychiatry. 17:1174–1179.
Katschnig H, Straßmayr C, Endel F, Berger M, Zauner G, Kalseth J, Sfetcu R, Wahlbeck K, Tedeschi F, Šprah L, CEPHOS-LINK study group (2019) Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations. Health Policy. 123:1028–1035.
Koch CG, Li L, Kaplan GA, Wachterman J, Shishehbor MH, Sabik J, Blackstone EH (2010) Socioeconomic position, not race, is linked to death after cardiac surgery. Circ Cardiovasc Qual Outcomes. 3:267–276.
Lyons JS, O'Mahoney MT, Miller SI, Neme J, Kabat J, Miller F (1997) Predicting readmission to the psychiatric hospital in a managed care environment: Implications for quality indicators. Am J Psychiatry. 154:337–340.
Maj M (2018) Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them. World Psychiatry. 17:121–122.
Marcus SC, Chuang C-C, Ng-Mak DS, Olfson M (2017) Outpatient follow-up care and risk of hospital readmission in schizophrenia and bipolar disorder. Psychiatr Serv. 68:1239–1246.
Mark TL, Mark T, Tomic KS, Kowlessar N, Chu BC, Vandivort-Warren R, Smith S (2013) Hospital readmission among Medicaid patients with an index hospitalization for mental and/or substance use disorder. J Behav Health Serv Res. 40:207–221.
Mason S, Graham NE (2002) Areas beneath the relative operating characteristics (ROC) and relative operating levels (ROL) curves: Statistical signié cance and interpretation. Q J Roy Meteorol Soc. 128:2145–2166.
Monnelly EP (1997) Instability before discharge and previous psychiatric admissions as predictors of early readmission. Psychiatr Serv. 48:1584–1586.
Montagni I, Salvador-Carulla L, Mcdaid D, Straßmayr C, Endel F, Näätänen P, Kalseth J, Kalseth B, Matosevic T, Donisi V, Chevreul K, Prigent A, Sfectu R, Pauna C, Gutiérrez-Colosia MR, Amaddeo F, Katschnig H (2018) The REFINEMENT glossary of terms: An international terminology for mental health systems assessment. Adm Policy Ment Health. 45:342–351.
Moos RH, McCoy L, Moos BS (2000) Global assessment of functioning (GAF) ratings: Determinants and role as predictors of one-year treatment outcomes. J Clin Psychol. 56:449–461.
Morrow-Howell NL, Proctor EK, Blinne WR, Rubin EH, Saunders JA, Rozario PA (2006) Post-acute dispositions of older adults hospitalized for depression. Aging Ment Health. 10:352–361.
Nelson EA, Maruish ME, Axler JL (2000) Effects of discharge planning and compliance with outpatient appointments on readmission rates. Psychiatr Serv. 51:885–889.
OECD (2013) Health at a glance 2013: OECD indicators. Available at: http://public.eblib.com/choice/publicfullrecord.aspx?p=2076906_0. Accessed March 31, 2019.
OECD (2014) Making mental health count—The social and economic costs of neglecting mental health care. Available at: http://www.oecd.org/publications/making-mental-health-count-9789264208445-en.htm. Accessed March 31, 2019.
Olfson M, Mechanic D, Boyer CA, Hansell S, Walkup J, Weiden PJ (1999) Assessing clinical predictions of early rehospitalization in schizophrenia. J Nerv Ment Dis. 187:721–729.
Priebe S, Katsakou C, Amos T, Leese M, Morriss R, Rose D, Wykes T, Yeeles K (2009) Patients' views and readmissions 1 year after involuntary hospitalisation. Br J Psychiatry. 194:49–54.
Regione Veneto (2016) News Salute Mentale Veneto. Available at: http://www.regione.veneto.it/c/document_library/get_file?uuid=b23fa96b-35a3-41a7-9acb-ad8208db1340&groupId=10793. Accessed March 31, 2019.
Royston P (1991) Estimating departure from normality. Stat Med. 10:1283–1293.
Ruf D (2016) Agglomeration effects and liquidity gradients in local rental housing markets. SSRN Electron J. doi: 10.2139/ssrn.2823708.
doi: 10.2139/ssrn.2823708
Rumball-Smith J, Hider P (2009) The validity of readmission rate as a marker of the quality of hospital care, and a recommendation for its definition. N Z Med J. 122:63–70.
Saleh ES, El-Hadidy MA (2013) Predictors of psychiatric early readmission in two Arab hospitals. Arab J Psychiatry. 23:12–21.
Schneeweiss S, Rassen JA, Glynn RJ, Avorn J, Mogun H, Brookhart MA (2009) High-dimensional propensity score adjustment in studies of treatment effects using health care claims data. Epidemiology. 20:512–522.
Sfetcu R, Musat S, Haaramo P, Ciutan M, Scintee G, Vladescu C, Wahlbeck K, Katschnig H (2017) Overview of post-discharge predictors for psychiatric re-hospitalisations: A systematic review of the literature. BMC Psychiatry. 17:227.
Steinert T, Wiebe C, Gebhardt RP (1999) Aggressive behavior against self and others among first-admission patients with schizophrenia. Psychiatr Serv. 50:85–90.
Stone M (1974) Cross-validatory choice and assessment of statistical predictions. J R Stat Soc B Methodol. 36:111–147.
Tedeschi F, Donisi V, Salazzari D, Cresswell-Smith J, Wahlbeck K, Amaddeo F (2019) Clinical and organizational factor predicting readmission for mental health patients across Italy. Soc Psychiatry Psychiatr Epidemiol. doi: 10.1007/s00127-019-01766-y.
doi: 10.1007/s00127-019-01766-y
Thompson EE, Neighbors HW, Munday C, Trierweiler S (2003) Length of stay, referral to aftercare, and rehospitalization among psychiatric inpatients. Psychiatr Serv. 54:1271–1276.
Tulloch AD, David AS, Thornicroft G (2016) Exploring the predictors of early readmission to psychiatric hospital. Epidemiol Psychiatr Sci. 25:181–193.
Velentgas P, Dreyer NA, Nourjah P, Smith SR, Torchia MM (Eds) (2013) Developing a protocol for observational comparative effectiveness research: A user's guide. Rockville, MD: Agency for Healthcare Research and Quality (US): Chapter 10. Available at: http://www.ncbi.nlm.nih.gov/books/NBK126190/. Accessed March 31, 2019.
Vigod SN, Kurdyak PA, Dennis CL, Leszcz T, Taylor VH, Blumberger DM, Seitz DP (2013) Transitional interventions to reduce early psychiatric readmissions in adults: Systematic review. Br J Psychiatry. 202:187–194.
Vigod SN, Kurdyak PA, Seitz D, Herrmann N, Fung K, Lin E, Perlman C, Taylor VH, Rochon PA, Gruneir A (2015) READMIT: A clinical risk index to predict 30-day readmission after discharge from acute psychiatric units. J Psychiatr Res. 61:205–213.
World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: WHO.
Zhang Z (2016) Multivariable fractional polynomial method for regression model. Ann Transl Med. 4:174.