(January 22, 2019) People with serious mental illness are two-times more likely to be readmitted within 30-days of discharge for a hospitalization for medical or surgical reasons compared to individuals without a mental illness, according to new research published earlier this month.
As has been previously reported, people suffering from the most severe psychiatric disorders have significantly higher rates of co-occurring physical health conditions, including hypertension, diabetes, and chronic kidney conditions - a fact that contributes to the 25-year difference in life expectancy for individuals suffering from severe mental illness compared to others. In addition to dealing with the barriers to treatment for one’s schizophrenia, bipolar disorder, or major depression, people with serious mental illness also have significant medical and surgical treatment needs due to their chronic physical conditions. To make matters worse, research has shown that individuals with serious mental illness receive lower quality medical care compared to other individuals. 
In new research published this month in JAMA Psychiatry, Dr. Hayley Germack and colleagues utilized the Nationwide Readmissions Database housed within the Department of Health and Human Services to study this phenomenon and determine how readmission rates differ among a nationally-represented sample of individuals with serious mental illness as compared to the general populations. The results have implications for hospital payments as the Centers for Medicare & Medicaid Services move towards service reimbursements for that are based on performance measures. The 30-day readmission rate is a quality of care indicator that is used for such payments.
The authors found that the 30-day medical readmission rate was 23.1% for individuals with serious mental illness, almost two-times greater than the 13.8% readmission rate for people without serious mental illness. For surgical hospitalizations, the 30-day readmission rate was 19.3% versus 9.4% for individuals with serious mental illness and those without, respectively. Even when statistically controlling for hospital characteristics and demographics, the odds of readmission for individuals with serious mental illness were significantly higher compared to those who had a medical or surgical hospitalization without a co-occurring serious mental illness.
The authors argue that these findings highlight a gap in care quality for individuals with serious mental illness that should be addressed by the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program. More research is needed to identify programs to prevent readmissions for patients with serious mental illness, as typical transitional care programs may not address the specific needs of this population.
For a previous analysis of hospital readmissions for individuals with schizophrenia, see our November 2017 Research Weekly blog post. The Treatment Advocacy Center also conducted our own analysis of readmission rates and length of stay for psychiatric hospitalizations, published in our November 2016 report Released, Relapsed, Rehospitalized.
Elizabeth Sinclair
Director of Research
Treatment Advocacy Center
References
· Germack, H. D., et al. (2019, January). Association of comorbid serious mental illness diagnosis with 30-day medical and surgical readmissions. JAMA Psychiatry.
