title: READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units.
abstract: Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.
authors.affiliation: Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada. Electronic address: simone.vigod@wchospital.ca.
authors.forename: Simone N
authors.initials: SN
authors.lastname: Vigod
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurdyak
authors.affiliation: Queens University, 99 University Avenue, Kingston, Ontario, Canada.
authors.forename: Dallas
authors.initials: D
authors.lastname: Seitz
authors.affiliation: University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada.
authors.forename: Kinwah
authors.initials: K
authors.lastname: Fung
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lin
authors.affiliation: University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Perlman
authors.affiliation: Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada.
authors.forename: Valerie H
authors.initials: VH
authors.lastname: Taylor
authors.affiliation: Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
authors.affiliation: Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada; Women's College Research Institute, 790 Bay Street, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada; University of Alberta, 6-40 University Terrace, Edmonton, Alberta, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D054928:Validation Studies as Topic; D055815:Young Adult
keywords: Psychiatric epidemiology; Psychiatric readmission; Risk index