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Service-related Factors Associated with the Risk of Readmission after Discharge from Psychiatric Hospitalization–Data from Large Psychiatric Hospital in Northern Taiwan

Chih-Ming Lin, Chung-Yi Li

Objectives:The prevalence of psychiatric disorders has gradually been in-creased since implementing Taiwan National Health Insurance (NHI) program. The study was intended to explore the incidence as well as demographic, clinical, and service-related predictors for readmission among psychiatric inpatients. Methods:Research data were retrieved from the inpatient and ambulatory care visit service claims of the Taiwan National Health Insurance Database. With a cohort study design, we included 789 inpatients discharged in 2004 from a 700-bed psy-chiatric hospital in Taiwan. With multivariate logistic regression models, we iden-tified significant predictors of readmission within one year after discharge. Results:The one-year readmission rate was estimated at 27.9%. Patients over 60 years of age had a significantly lower rate of one-year readmission than those aged ≤14 years (adjusted odds ratio: 0.32; 95% confidence interval: 0.11-0.87). Patients suffering from affective psychoses and those were exempted from co-payments, were found to have significantly higher risks (AOR = 1.90; 95% CI: 1.07-3.35 and AOR = 2.07; 95% CI: 1.33-3.21), respectively, of readmission. Patients who re-ceived scheduled ambulatory care visits or those who received access to commu-nity rehabilitation programs were not related to readmission within one year after discharge. Conclusion:In addition to demographic and clinical characteristics, the service-related factors may influence readmission under the Taiwan NHI system. Aftercare policy decision makers should assess whether medical resources avail-able for treating post-discharge psychiatric patients are maximally allocated. We suggest that further investigations focusing on individual- and system-level barri-ers to facilitating and accessing such psychiatric rehabilitation programs are warranted.
Key Word aftercare, length of stay, psychiatric inpatient, service-related factors
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