Journal of Shandong University (Health Sciences) ›› 2025, Vol. 63 ›› Issue (3): 99-109.doi: 10.6040/j.issn.1671-7554.0.2024.1054

• Public Health & Preventive Medicine • Previous Articles    

Causal associations between length of stay and readmission rates in patients with mental disorders

YUAN Ying1,2,3, ZHANG Shuaijie1,2,3, SUN Shuangshuang1,2,3, ZHANG Botao1,2,3, XU Zhaoke2,4, HU Xifeng1,2,3, YU Yuanyuan2,5, XUE Fuzhong1,2,3   

  1. 1. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Healthcare Big Data Research Institute, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250003, Shandong, China;
    3. Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    4. School of Information Science and Engineering, Shandong Normal University, Jinan 250039, Shandong, China;
    5. Data Science Institute, Shandong University, Jinan 250100, Shandong, China
  • Published:2025-04-08

PDF (PC)

337

Abstract: Objective To explore the causal associations between length of stay(LOS)and readmission rates among patients with mental disorders, so as to provide evidence for improving patient prognosis and refining clinical management. Methods A real-world, new-user cohort was constructed using the Cheeloo Lifespan Electronic-Health Research Data-library. Patients were categorized into five groups based on LOS, with the middle group(15-30 days)as the control and the other four groups(1-7, 8-14, 31-60, 61-90 days)as treatment groups. L1 regularization was used for high-dimensional variable selection, followed by propensity score matching using 1∶1 nearest-neighbor match with a defined caliper. The matching quality was assessed via comparability and balance diagnostics. The proportional hazards models were applied to evaluate the causal associations between LOS and 1-year readmission rates, including both mental disorder-related and all-cause readmissions. Results A total of 22,437 mental disorder inpatients were included, with baseline data comprising 1,794 covariates, covering demographics, hospitalization, disease, medication, and procedure information. L1 regularization selected 374, 293, 293 and 255 variables for matching. Balance diagnostics indicated all covariates were well-balanced. Compared with patients hospitalized for 15 to 30 days, patients with a LOS of 1 to 7 days had significantly reduced 1-year mental disorder-related readmission rate(HR=0.54; 95%CI: 0.46-0.65)and all-cause readmission rate(HR=0.75; 95%CI: 0.67-0.84); patients with a LOS of 8 to 14 days had a significantly lower rate of 1-year mental disorder-related readmission(HR=0.85; 95%CI: 0.74-0.99); patients with a LOS of 61 to 90 days had a significantly increased rate of 1-year mental disorder-related readmission(HR=1.37; 95%CI: 1.15-1.63). Conclusion The 1-year mental disorder-related readmission rate among patients with mental disorders showed an increasing trend with longer LOS, but this trend was not significant between the longer stay group(31-60 days)and the control group. All-cause readmission rates were significantly lower only in the very short stay group(1-7 days). These results indicate that LOS significantly affects the readmission rates of patients with mental disorders. Shortening LOS does not increase the risk of readmission, whereas excessively prolonged LOS predicts higher readmission rates. This finding provides evidence to inform more effective hospital management decisions in clinical practice.

Key words: Mental disorder, Length of stay, High-dimensional variable selection, Readmission, Real-word study

CLC Number: 

  • R197
[1] Wu Y, Wang L, Tao MJ, et al. Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years[J]. Epidemiol Psychiatr Sci, 2023, 32: e63. doi:10.1017/S2045796023000756
[2] Huang YQ, Wang Y, Wang H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3): 211-24.
[3] Arias D, Saxena S, Verguet S. Quantifying the global burden of mental disorders and their economic value[J]. EClinicalMedicine, 2022, 54: 101675. doi:10.1016/j.eclinm.2022.101675
[4] Duke GJ, Moran JL, Bersten AD, et al. Hospital-acquired complications: the relative importance of hospital- and patient-related factors[J]. Med J Aust, 2022, 216(5): 242-247.
[5] Eldridge N, Wang Y, Metersky M, et al. Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019[J]. JAMA, 2022, 328(2): 173-183.
[6] Hauck K, Zhao XY. How dangerous is a day in hospital? A model of adverse events and length of stay for medical inpatients[J]. Med Care, 2011, 49(12): 1068-1075.
[7] Wesselius HM, van den Ende ES, Alsma J, et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients[J]. JAMA Intern Med, 2018, 178(9): 1201-1208.
[8] ZHOU Yanling, Rosenheck RA, Mohamed S, et al. Retrospective assessment of factors associated with readmission in a large psychiatric hospital in Guangzhou, China[J]. Shanghai Archives of Psychiatry, 2014, 26(3): 138-148.
[9] Botha UA, Koen L, Joska JA, et al. The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country[J]. Soc Psychiatry Psychiatr Epidemiol, 2010, 45(4): 461-468.
[10] 李欣洁. 精神障碍住院患者出院后1年内再住院的危险因素[D]. 广州: 广州医科大学, 2022.
[11] Gobbicchi C, Verdolini N, Menculini G, et al. Searching for factors associated with the "Revolving Door phenomenon" in the psychiatric inpatient unit: A 5-year retrospective cohort study[J]. Psychiatry Res, 2021, 303: 114080. doi:10.1016/j.psychres.2021.114080
[12] 司书成. 大数据背景下真实世界研究设计与分析策略: 以2型糖尿病药物治疗远期结局评价为例[D]. 济南: 山东大学, 2022.
[13] Luijken K, Spekreijse JJ, van Smeden M, et al. New-user and prevalent-user designs and the definition of study time origin in pharmacoepidemiology: a review of reporting practices[J]. Pharmacoepidemiol Drug Saf, 2021, 30(7): 960-974.
[14] Lund JL, Richardson DB, Stürmer T. The active comparator, new user study design in pharmacoepidemiology: historical foundations and contemporary application[J]. Curr Epidemiol Rep, 2015, 2(4): 221-228.
[15] Tibshirani R. Regression shrinkage and selection via the lasso[J]. J R Stat Soc Ser B Stat Methodol, 1996, 58(1): 267-288.
[16] Tian YX, Schuemie MJ, Suchard MA. Evaluating large-scale propensity score performance through real-world and synthetic data experiments[J]. Int J Epidemiol, 2018, 47(6): 2005-2014.
[17] Rosenbaum PR, Rubin DB.The central role of the propensity score in observational studies for causal effects[J]. Biometrika, 1983, 70(1): 41-55.
[18] Newman L, Harris V, Evans LJ, et al. Factors Associated with Length of Stay in Psychiatric Inpatient Services in London, UK[J]. Psychiatric Quarterly, 2018, 89(1): 33-43.
[19] Masters GA, Baldessarini RJ, Öngür D, et al. Factors associated with length of psychiatric hospitalization[J]. Compr Psychiatry, 2014, 55(3): 681-687.
[20] Silva M, Antunes A, Loureiro A, Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal[J]. Psychiatry Res, 2020, 293: 113420. doi:10.1016/j.psychres.2020.113420
[21] Barruel D, Perozziello A, Lefèvre H, et al. Predictors of the length of stay in psychiatric inpatient units: a retrospective study for the Paris Psychiatry Hospital Group[J]. Frontiers in Psychiatry, 2024, 15. doi:10.3389/fpsyt.2024.1463415
[22] Gentil L, Grenier G, Vasiliadis HM, Predictors of Length of Hospitalization and Impact on Early Readmission for Mental Disorders[J]. International Journal of Environmental Research and Public Health, 2022, 19(22): 15127.
[23] 马亚伟, 张欢, 贾敏, 等. 精神科开放病房与封闭病房精神分裂症患者的住院时长比较[J]. 临床医学研究与实践, 2024, 9(19): 13-16. MA Yawei, ZHANG Huan, JIA Min, et al. Comparison of length of stay of schizophrenia patients in psychiatric open ward and closed ward[J]. Clinical Research and Practice, 2024, 9(19): 13-16.
[24] Rubin DB. Using propensity scores to help design observational studies: application to the tobacco litigation[J]. Health Serv Outcomes Res Methodol, 2001, 2(3): 169-188.
[25] Yang D, Dalton JE. A unified approach to measuring the effect size between two groups using SAS[C]. SAS Global Forum, 2012, 335: 1-6.
[26] Curtin F, Schulz P. Multiple correlations and bonferronis correction[J]. Biol Psychiatry, 1998, 44(8): 775-777.
[27] VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value[J]. Ann Intern Med, 2017, 167(4): 268-274.
[28] Del Favero E, Montemagni C, Villari V, et al. Factors associated with 30-days and 180-days psychiatric readmissions: a snapshot of a metropolitan area[J]. Psychiatry Res, 2020, 292: 113309. doi:10.1016/j.psychres.2020.113309
[29] Gastal FL, Andreoli SB, Quintana MI, et al. Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses[J]. Rev Saude Publica, 2000, 34(3): 280-285.
[30] Zhang JY, Harvey C, Andrew C. Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study[J]. Aust N Z J Psychiatry, 2011, 45(7): 578-585.
[31] Docrat S, Besada D, Cleary S, et al. The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review[J]. Health Econ Rev, 2020, 10(1): 1-23.
[32] Jakovljevic M, Chang HY, Pan J, et al. Successes and challenges of Chinas health care reform: a four-decade perspective spanning 1985-2023[J]. Cost Eff Resour Alloc, 2023, 21(1): 59.
[33] 樊献丽, 吴建杰, 王艳, 等. 多学科诊疗模式下的个体化康复治疗对精神分裂症患者住院康复疗效的影响[J]. 国际医药卫生导报, 2018, 24(8): 1154-1157. FAN Xianli, WU Jianjie, WANG Yan, et al. Impact of personal rehabilitation treatment training by multiple disciplinary team on recovery of schizophrenia patients[J]. International Medicine and Health Guidance News, 2018, 24(8): 1154-1157.
[1] LAN Hongtao, JIA Xu, TONG Zhoujie, ZHENG Man, HU Boang, ZHONG Ming, ZHANG Wei, WANG Zhihao. Readmission prediction of 152 non-selective adult patients with chronic heart failure [J]. Journal of Shandong University (Health Sciences), 2021, 59(4): 63-69.
[2] LI Xiangyi, WANG Qingliang, ZHANG Yongyuan, LIU Yingjun, FEI Jianchun, YANG Jie, ZHANG Yi. Analysis of influencing factors of prolonged length of stay in a tertiary hospital based on generalized estimation equation [J]. Journal of Shandong University (Health Sciences), 2021, 59(1): 102-107.
[3] ZHANG Chuanbei, LI Fang, ZHAI Chunxiao, YU Yongming, SHU Minglei, WANG Yidan, XU Liangdong, HAO Enkui. Gaussian process model for risk assessment of readmission for patients with chronic heart failure within one year [J]. Journal of Shandong University (Health Sciences), 2020, 58(6): 28-33.
[4] ZHANG Yongyuan, WANG Qingliang, LI Xiangyi, LIU Yingjun, FEI Jianchun, YANG Jie. A study of unplanned readmission within 31 days during 2018 in a tertiary hospital in Jinan [J]. Journal of Shandong University (Health Sciences), 2020, 58(2): 90-95.
[5] YUAN Xin, ZHENG Zhe, HU Sheng-shou. Application value of EuroSCORE in predicting readmission
after coronary artery bypass graft [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(8): 77-80.
[6] WANG Hong-wei,LIU Shuang-de,TIAN Chuan,YAN Jie-ke,XU Dong-sheng,ZHENG Wan-hong. Vesania after kindney transplantation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(10): 1072-1075.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd