Continuity of care and readmission in two service systems: a comparative Victorian and Groningen case-register study.
OBJECTIVE
We compared service consumption, continuity of care and risk of readmission in a record linkage follow-up study of cohorts of patients with schizophrenia and related disorders in Victoria (Australia) and in Groningen (The Netherlands). These areas are interesting to compare because mental health care is in a different stage of deinstitutionalization. More beds are available in Groningen and more community resources are available in Victoria.


METHODS
The cohorts were followed for 4 years, since discharge from inpatient services using record linkage data available in the psychiatric case-registers in both areas. Survival analysis was used to study continuity of care and risk of readmission.


RESULTS
Available indicators showed a higher level of continuity of care in Victoria. While the relative risk of readmission was the same in both areas and not affected by aftercare contact after discharge, the number of days spent in hospital was much higher in the Groningen register area.


CONCLUSIONS
These findings provide further support for earlier reports that the risk of readmission is predominantly affected by attributes of mental illness. However, the duration of admissions, is strongly affected by service system variables, including the provision of continuity of care.
Sytema
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S
Department of Psychiatry, University of Groningen, The Netherlands.
Burgess
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P
D000293:Adolescent; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012306:Risk; D012559:Schizophrenia / Q000517:prevention & control / Q000628:therapy*; D016019:Survival Analysis; D014739:Victoria