Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People.
BACKGROUND
This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group.


METHODS
We sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year.


RESULTS
Forty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR=.96, 95% CL=.94, .99, P=.002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status.


CONCLUSIONS
The GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare.
University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America. Electronic address: Ursula.RunningBear@ucdenver.edu.
Ursula
U
Running Bear
University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, 12850 E. Montview Blvd, Mail Stop C238, Aurora, CO 80045, United States of America.
Heather
H
Anderson
University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America.
Spero M
SM
Manson
University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America; University of Colorado Anschutz Medical Campus, Department of Psychiatry, 13055 East 17th Avenue, Aurora, CO 80045, United States of America.
Jay H
JH
Shore
University of Colorado Anschutz Medical Campus, Department of Medicine, Academic Office One, 12631 E. 17th Avenue, Aurora, CO 80045, United States of America; Ambulatory Care 11B, Denver VA Medical Center, 1055 Clermont, Denver, CO 80220, United States of America.
Allan V
AV
Prochazka
University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America; University of Colorado Anschutz Medical Campus, Department of Psychiatry, 13055 East 17th Avenue, Aurora, CO 80045, United States of America.
Douglas K
DK
Novins
D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D000413:Alaska / Q000453:epidemiology; D000430:Alcohol Withdrawal Delirium / Q000534:rehabilitation; D000437:Alcoholism / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*; D044467:American Indian or Alaska Native / Q000523:psychology* / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010359:Patient Readmission; D012640:Seizures / Q000209:etiology / Q000534:rehabilitation; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome
Alaska Native People; American Indian; Detoxification; Readmission; Substance abuse treatment