title: Statistical methods and modelling techniques for analysing hospital readmission of discharged psychiatric patients: a systematic literature review.
abstract: BACKGROUND
  Psychiatric services have undergone profound changes over the last decades. CEPHOS-LINK is an EU-funded study project with the aim to compare readmission of patients discharged with psychiatric diagnoses using a registry-based observational record linkage study design and to analyse differences in the findings for five different countries. A range of different approaches is available for analysis of the available data. Although there are some studies that compare selected methods for evaluating questions on readmission, there are to our knowledge no published systematic literature reviews on commonly used methods and their comparison. This work shall therefore provide an overview of the methods in use, their evolution throughout history and new developments which can further improve the research quality in this area.
  
  
  METHODS
  Based on systematic literature reviews realized in the course of the CEPHOS-LINK study, this work is a systematic evaluation of mathematical (statistical and modelling) methods used in studies examining psychiatric readmission. The starting point were 502 papers, of which 407 were analysed in detail; Methods used were assigned to one of five categories with subcategories and analysed accordingly. Our particular interest next to survival analysis and regression models is modelling and simulation.
  
  
  RESULTS
  As population sizes and follow-up times in the included studies varied widely, a range of methods was applied. Studies with bigger sample sizes conducted survival and regression analysis more often than studies with fewer patients did. These latter relied more on classical statistical tests (e.g. t-tests and Student Newman Keuls). Statistical strategies were often insufficiently described, posing a major problem for the evaluation. Almost all cases failed to provide and explanation of the rationale behind using certain methods.
  
  
  CONCLUSIONS
  There is a discernible trend from classical parametric/nonparametric tests in older studies towards regression and survival analyses in more recent ones. Modelling and simulation were under-represented despite their high usability, as has been identified in other health applications and comparable research areas.
authors.affiliation: DWH Simulation Services, Neustiftgasse 57-59, 1070, Vienna, Austria. christoph.urach@dwh.at.|Institute of Analysis and Scientific Computing, Vienna University of Technology, Wiedner Hauptstraße 8 - 10, 1040, Vienna, Austria. christoph.urach@dwh.at.
authors.forename: Christoph
authors.initials: C
authors.lastname: Urach
authors.affiliation: DWH Simulation Services, Neustiftgasse 57-59, 1070, Vienna, Austria.
authors.forename: Günther
authors.initials: G
authors.lastname: Zauner
authors.affiliation: National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
authors.affiliation: National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Peija
authors.initials: P
authors.lastname: Haaramo
authors.affiliation: DWH Simulation Services, Neustiftgasse 57-59, 1070, Vienna, Austria.|Dexhelpp, Neustiftgasse 57-59, 1070, Vienna, Austria.
authors.forename: Niki
authors.initials: N
authors.lastname: Popper
mesh_terms: D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data
keywords: Evaluation of research methods; Mathematical methods; Psychiatric disorders; Readmission; Systematic review