An analysis of hospital readmission and continuity of care in an urban community mental health center
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Authors
Barto, Sherry
Issue Date
1979
Type
Thesis
Language
en
Keywords
Community mental health centers , Hospital readmission studies
Alternative Title
Abstract
This study describes frequency of hospitalization and rehospitalization in an Urban Community Mental Health Center. It also examines aspects of the continuity of care received by patients discharged from the hospital, and the relationship between rehospitalization and continuity of care.
One of the major tenets of modern mental health treatment philosophy is that treatment should take place in the patient's own community with as little interruption of normal life as possible. It has been assumed that the provision of continuity of care for patients discharged from the hospital can reduce the probability that a patient will be rehospitalized and assist the patient to maintain a normal life in the community.
This study is based on the records of a continuing care team which receives copies of hospital discharge plans and monitors the continuity of care received-by the patients discharged. Samples were taken of patients discharged initially between July 1, 1975 and June 30, 1978. Frequency counts were made of hospitalizations, rehospitalizations and completed referrals. Statistical tests were used to determine the significance of the relationship between referral completion or treatment termination and rehospitalization.
It was found that during this study 70 percent of the patients were discharged from the hospital once, 14 percent were discharged twice and 16 percent were discharged between three and seven times. When patients were discharged from a hospital and referred to the Community Mental Health Center for treatment, 56 percent of the referrals were completed by patients who were seen at least once at the new treatment unit. Efforts to improve continuity of care by providing outreach when the referral process was not completed by patients on their own resulted in an increase of completed referrals from 56 percent to 58 percent. There was no apparent relationship between completion of the referral process and rehospitalization. When referrals were completed, 51 percent were rehospitalized. When referrals were not completed, 47 percent were rehospitalized. There was a significant relationship between remaining in treatment and rehospitalization. When patients remained in treatment after completing the referral, 70 perdent were rehospitalized. When patients terminated treatment after completing the referral, 33 percent were rehospitalized.
It appeared that the high mobility of the population in this Urban Community Mental Health District was strongly reflected in the data: in the high percentage of one time only hospital discharges and in the lack of any positive relationship between continuity of care and remaining in the community. Because patients who do not receive continuity of care enter the category of "whereabouts and status unknown", comparing them to patients receiving continuity of care does not provide legitimate grounds for drawing conclusions about the effectiveness of Community Mental Health Centers in assisting their patients to maintain their normal lives in their community. It is recommended that descriptive findings be used to develop goals for the Community Mental Health Center. The degree to which these goals are met would then provide a basis for fruitful evaluation.