1. Psychiatric readmission in norway
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Eva Lassemo, Jorid Kalseth
SINTEF Technology and Society, Health, Trondheim, Norway

2. Background
Little is known about the composition of the relatively high Norwegian psychiatric readmission rate.
A three-tier structure of Norwegian mental health care services:
Hospitals: are responsible for specialist health services that can only be performed at hospital level, such as secure wards, closed emergency departments and some other limited functions.
District psychiatric centers (DPCs): responsible for providing specialized mental health services in the form of outpatient, ambulatory or inpatient treatment + assist the municipal mental health services with counselling
General practitioners (GPs) and out-patient specialists

3. Objective To decompose the Norwegian psychiatric readmission rate.
Hospital vc DPC
All vs acute index admission
Contextual and system level factors

4. Methods
Registry data from the Norwegian Patient Register (NPR) index year (N=17,158)
Merged with municipal data
Discharged from index stay with F2-F6 ICD-10 diagnosis
Risk of readmission within 30 (and 365 days)
Conditional risk of readmission from acute admission
Multilevel logistic regression

5. Descriptives More women in population, and readmitted
Discharged from hospital:
More men
The young and the old
"Heavier" diagnoses
More comorbid substance abuse
The short and the long LOS
Live close to hospital
More acute admissions

6. Results - descriptives
Patients discharged from hospital readmitted more often

7. Logistic regression With only individual level variables: OR 95% CI
DPC
Ref -
Mix
1.37
Hospital
0.97

8. Female
1.20*
( )
25-39 Y
0.88*
( )
40-65
0.79*
( )
66+
0.76*
( ) F2
1.62*
( )
F30-31
1.45*
( ) F4
0.96
( ) F5
1.97*
( ) F6
1.81*
( )
subst_com
1.22*
( )
5-14 LOS
0.84*
( )
15-29
0.68*
( )
30-59
0.51*
( )
60+
0.59*
( )
acute
1.54*
( )

9. Multilevel logistic regression

10. All discharges from DPC
Higher OR 30d readmission
Lower OR 30d readmission
Medium level GP/ pop
Long distance to hospital
Medium and more mental health workers in comm.
Medium aLOS in DPC area

11. Discharges from acute DPC
Higher OR 30d readmission
Lower OR 30d readmission
High rate of GP/ comm.
Long distance to hospital
Decreasing with more mental health workers in comm.
Medium aLOS in DPC area

12. All discharges from hospital
Higher OR 30d readmission
Lower OR 30d readmission
Medium level GP/ pop
Long distance to hospital
Higher rate out-patient treatments/ capita at DPC in DPC area
Short distance to DPC
Medium and high aLOS in DPC area

13. Discharges from acute hospital
Higher OR 30d readmission
Lower OR 30d readmission
Medium rate of GP/ comm.
Higher rate out-patient treatments/ capita at DPC in DPC area
Decreasing with longer distance to hospital
Decreasing with longer aLOS in DPC area
Low aLOS in hospital area

14. Discussion Patient characteristics are important for readmission
Different systems have different patients
System level factors are important for readmission
Community services important for DPC patients
Importance of planned readmissions – 67.8% 30d

15. Implications To reduce readmission rates:
Strengthen community mental health services
Maintain number of beds
Not all readmissions are unwanted

16. Thank you! eva.Lassemo@sintef.no