title: Pre- and post-discharge factors influencing early readmission to acute psychiatric wards: implications for quality-of-care indicators in psychiatry.
abstract: OBJECTIVE
  This study aims to describe the association between pre- and post-discharge factors and early readmission to acute psychiatric wards in a well-integrated community-based psychiatric service.
  
  
  METHODS
  The analysis consisted of all the hospital discharge records containing a psychiatric diagnosis in 2011 from four Italian acute inpatient wards. Socio-demographic, clinical, admission and aftercare variables were investigated as possible predictors of readmission at 7, 30 and 90 days after discharge and were analyzed, controlling for dependency among same-patient observations.
  
  
  RESULTS
  Previous psychiatric history was the most important predictor of readmissions. The socio-demographic and clinical characteristics of patients did not clearly influence readmission. Length of stay (LoS) was significant for readmission at 7 days even after controlling for other predictors and for same-patient dependence, in particular, for patients with previous admissions. Results suggest a protective role of a LoS higher than 28 days. In general, having a contact in community services did not turn out as protective from early readmission.
  
  
  CONCLUSIONS
  This paper contributes to increase the knowledge about factors that may predict the risk of early readmission. Implications for quality assessment in psychiatry emerged: readmission seems actionable by LoS and not by community follow-up.
authors.affiliation: Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy. Electronic address: valeria.donisi@univr.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Donisi
authors.affiliation: Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Tedeschi
authors.affiliation: Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Salazzari
authors.affiliation: Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Amaddeo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Continuity of care; Length of stay; Psychiatric services; Quality of care; Readmission