New Quality Measure to Evaluate Psychiatric Hospital Readmissions

University of Florida Health (UF) researchers have partnered with the Health Services Advisory Group (HSAG) to complete a new quality measure for CMS to evaluate care in psychiatric hospitals worldwide. The quality measures specifically look at hospital readmission in psychiatric settings.

“Hospital readmission is a significant problem for psychiatric patients,” said Almut Winterstein, Rph, PhD, FISPE, a professor and the Dr. Robert and Barbara Crisafi chair in pharmaceutical outcomes and policy in the UF College of Pharmacy. “We found one in five patients admitted to the hospital for a psychiatric condition end up being readmitted within 30 days and almost half require inpatient care within six months,” Winterstein, who is also the director of the UF center for drug evaluation and safety, added.

The measure tracks 30-day hospital readmission rates for psychiatric patients following discharge in nearly 1,700 psychiatric hospitals worldwide. More than 50 risk factors for readmission were assessed in developing the measure, which included age, type of illness, and other patient conditions.

Among the measures assessed, dementia, personality and schizoaffective disorders and psychosis posed the highest risk for readmission.

"The underlying illness could not explain the disparity of readmission rates across facilities, though,” said Regina Bussing, M.D., MSHS, the study’s medical director and a professor of psychiatry. “Studies suggest that comprehensive hospital discharge ensure that patients have medical and social support and other interventions can make a big difference,” said Bussing who is also the Donald R. Dizney chair in psychiatry and chair of the department of psychiatry in the UF College of Medicine.

CMS adopted the measure last year after a multiyear study that examined more than 700,000 admissions to inpatient psychiatric facilities. UF College of Pharmacy researchers uncovered that nearly 150,000 (21 percent) of those admissions resulted in planned readmissions soon after discharge.

The readmission rates varied by facility, ranging from 11 percent to 35 percent after differences in clinical risk factors of patients across facilities were considered.

“This means the measure we developed was able to determine differences in care across psychiatric facilities,” said Amie Goodin, PhD, assistant professor of pharmaceutical outcomes and policy in the UF College of Pharmacy and co-author of the study. “This information will allow inpatient psychiatric facilities to improve care for their patients by developing targeted interventions that will best serve their individual communities.”

The new quality measure provides a barometer by which CMS healthcare providers and consumers can assess how effectively hospitals are delivering inpatient psychiatric care, UF researchers highlighted. The tool also aims to create a level playing field for comparing inpatient psychiatric facilities across the country.

Additionally, the model can also point hospitals to those patients at highest risk for readmission to concentrate care efforts.

“What we are doing is trying to find a way to make the comparisons fair and to see who is really doing a good job of providing psychiatric care and who needs more help,” Goodin said.