Effects of Discharge Planning and Compliance With Outpatient Appointments on Readmission Rates

Abstract

This study examined whether patients discharged from inpatient psychiatric care would have lower rehospitalization rates if they kept an outpatient follow-up appointment after discharge. Complete data were collected in 1998 on 3,113 psychiatric admissions in eight Southeastern states; 542 were readmissions. Patients' health care was managed by United Behavioral Health of Georgia (UBH-GA), which encouraged inpatient facilities to ensure that an outpatient appointment was scheduled for all discharged patients. UBH-GA contacted outpatient providers to determine whether patients kept at least one appointment. Rehospitalization rates were calculated for 90, 180, 270, and 365 days after discharge to examine effects over time of keeping an initial appointment. Of the 542 patients who were rehospitalized, 136 kept at least one outpatient appointment after discharge from their initial admission; 406 did not. For patients who did not keep an appointment, rehospitalization rates increased over time, ranging from 15 percent to 29 percent. For patients who kept an outpatient appointment, the rehospitalization rate remained the same over time, about 10 percent. The 270- and 365-day rehospitalization rates and the aggregated annual rates were significantly higher (p>.01) for patients who did not keep an appointment. Patients who did not have an outpatient appointment after discharge were two times more likely to be rehospitalized in the same year than patients who kept at least one outpatient appointment. Aggregated annual rates indicated that patients who kept appointments had a one in ten chance of being rehospitalized, whereas those who did not had a one in four chance.