title: Length of stay, referral to aftercare, and rehospitalization among psychiatric inpatients.
abstract: OBJECTIVE
  This retrospective study explored the interrelationship among aftercare, length of hospital stay, and rehospitalization within six months of discharge in a sample of psychiatric inpatients.
  
  
  METHODS
  Data were analyzed for 1,481 patients who had received inpatient care at a state psychiatric hospital from November 1991 to July 1994. Logistic regression models were estimated to predict the likelihood of referral to aftercare and of readmission to a hospital within six months of the index discharge. Variables controlled for were patients' characteristics; psychiatric status at the time of discharge, including length of stay; and the availability of informal support.
  
  
  RESULTS
  Sixteen percent of the patients received a referral to aftercare, and about 13 percent of the patients were readmitted within six months of discharge. White patients were twice as likely as African Americans to receive a referral to aftercare. Length of hospitalization and having a diagnosis of schizophrenia were also predictors of referral to aftercare. Referral to aftercare was not shown to mediate the relationship between length of stay and rehospitalization. However, having a schizoaffective disorder, a poor discharge prognosis, and a high number of previous admissions were associated with an increased risk of readmission. No other demographic characteristics were related to readmission within six months of discharge, but referral to aftercare significantly increased the risk of readmission.
  
  
  CONCLUSIONS
  The study suggested the possibility of racial disparities in referral to aftercare and a complex relationship between referral and rehospitalization. Both these findings warrant further investigation that gives particular attention to individual-level indicators of need and system-level barriers to and facilitators of psychiatric care.
authors.affiliation: Department of Public and Commuinity Health, University of Maryland, College Park, MD 20742-2611, USA. estina@wam.umd.edu
authors.forename: Estina E
authors.initials: EE
authors.lastname: Thompson
authors.forename: Harold W
authors.initials: HW
authors.lastname: Neighbors
authors.forename: Cheryl
authors.initials: C
authors.lastname: Munday
authors.forename: Steve
authors.initials: S
authors.lastname: Trierweiler
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care; D005260:Female; D006302:Health Services Research; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006783:Hospitals, State / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D001523:Mental Disorders / Q000145:classification / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies