Variability in psychiatric medical practice evaluated by studying short-term psychiatric rehospitalization

Abstract

Introduction. Variability in medical practice can detect deficiencies in medical care quality. This study was designed to determine variations in psychiatric practice by studying short-term rehospitalization (SRH) that could result in differences in quality of psychiatric care.

Methods. Data on 894 consecutive admissions to an inpatient unit from March to December 2001 were collected. Readmissions over the next 90 days or less (SRH) were analyzed. The database was reviewed in order to extract information about several variables: age, gender, period from the first admission, number of previous admissions, interval between initial discharge and readmission, psychiatric diagnosis, aftercare provided by the mental health centers (MHC) and psychiatrist-associated variables. Differences between SRH and the other admissions were examined.

Results. There were significant variations in the aftercare provided by the MHC (p=0.028). There were also variations in the psychiatrist responsible for the inpatient unit (p=0.03), in the reference psychiatrist in a MHC (p=0.007), but not in the emergency unit.

Conclusions. This short-term rehospitalization study showed variations in quality of aftercare and in psychiatrist-associated variables. Both these findings warrant further investigation that pays specific attention to staff attitudes, system barriers and facilitators of psychiatric care.