The Impact of Hospital Characteristics on Psychiatry Readmissions: A Mediation Framework

Abstract

We study the operational characteristics of hospitals contributing to the readmission of psychiatry patients, shortly after being discharged. We propose that the length of stay (LOS) in the inpatient ward mediates the effects of hospital characteristics on the risk of readmission. We utilize a data set of about 15,000 psychiatry patients admitted to 25 hospitals in Canada. We use a clustered-error probit model which we adjust for endogeneity through instrumental variables to conduct a causal analysis. In our mediation framework, we find that the number of patients admitted to a hospital annually, i.e., patient volume, increases the risk of readmission, whereas this risk reduces with the hospital specializing in certain diagnosis classes, i.e., hospital focus. These relationships are moderated by patients’ intensity of resource usage at the emergency department. Moreover, we find a nonlinear relationship between LOS and the risk of readmission. A widely observed phenomenon in operations management is “practice makes perfect”, which constitutes a positive volume-outcome relationship. The nature of this relationship, however, may change in people-centric environments, such as health systems. We provide evidence for the negative relationship among the patient volume and the risk of readmission. Our results provide insights for policy makers to manage the burden imposed on the health systems by unplanned readmissions from patients with chronic disorders. Our empirical analysis provides potentially helpful insights for managing the flow of psychiatric patients.

Note:
Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have conducted this study independently and have not received any financial support related to this work.

Conflict of Interests: The authors declare that they have no competing interests, either financial or non-financial, related to the subject matter or materials discussed in this manuscript.

Ethical Approval: This study was approved by the ethics committee at ST. MARY'S HOSPITAL CENTER - RESEARCH REVIEW OFFICE. Any identifying information has been removed to protect the privacy and confidentiality of the study participants.

Keywords: Readmissions, Mental health care, Hospital characteristics, Length of stay, Mediation analysis