Measurement of unnecessary psychiatric readmissions in the context of care transition interventions: a scoping review.


Kim B(1)(2), Weatherly C(3), Wolk CB(4), Proctor EK(3).
Author information:
(1)HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA [Email]
(2)Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
(3)George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA.
(4)Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.


OBJECTIVE: The objective of this study was to examine how published studies of inpatient to outpatient mental healthcare transition processes have approached measuring unnecessary psychiatric readmissions. DESIGN: Scoping review using Levac et al's enhancement to Arksey and O'Malley's framework for conducting scoping reviews. DATA SOURCES: Medline (Ovid), Embase (Ovid), PsycINFO, CINAHL, Cochrane and ISI Web of Science article databases were searched from 1 January 2009 through 28 February 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies that (1) are about care transition processes associated with unnecessary psychiatric readmissions and (2) specify use of at least one readmission time interval (ie, the time period since previous discharge from inpatient care, within which a hospitalisation can be considered a readmission). DATA EXTRACTION AND SYNTHESIS: We assessed review findings through tabular and content analyses of the data extracted from included articles. RESULTS: Our database search yielded 3478 unique articles, 67 of which were included in our scoping review. The included articles varied widely in their reported readmission time intervals used. They provided limited details regarding which readmissions they considered unnecessary and which risks they accounted for in their measurement. There were no perceptible trends in associations between the variation in these findings and the included studies' characteristics (eg, target population, type of care transition intervention). CONCLUSIONS: The limited specification with which studies report their approach to unnecessary psychiatric readmissions measurement is a noteworthy gap identified by this scoping review, and one that can hinder both the replicability of conducted studies and adaptations of study methods by future investigations. Recommendations stemming from this review include (1) establishing a framework for reporting the measurement approach, (2) devising enhanced guidelines regarding which approaches to use in which circumstances and (3) examining how sensitive research findings are to the choice of the approach.