Continuity of care and risk of hospital readmission among dual diagnosis patients

Abstract

The present study investigated the effects of added outpatient services aimed at reintegration assistance and prolonged aftercare on continuity of care and risk of re-hospitalization among patients suffering from both a severe mental illness and a substance use disorder. Administrative data on inpatient and outpatient care of all patients with at least one inpatient treatment episode at the treatment facility for dual diagnosis patients (CDP) of the Parnassia Bavo Psychiatric Institute in The Hague were analyzed (n = 616). The CDP began in 1996 as an inpatient service. In early 1999, the CDP was expanded by outpatient services. The time between discharge and readmission was estimated in a survival time analysis in connection with calendar year (1996–2006) and patient's characteristics. No consistent or substantial differences in the duration of first in-hospital stay at the CDP could be established. The time from admission to enrollment in an outpatient program decreased and the number of outpatient days with actual presence increased. The median interval between discharge and first readmission increased from 308 days among those discharged in 1996–1998 to 490 for those discharged in 1999–2001. However, this reduction in risk of re-hospitalization disappeared after adjustment for the presence of a psychotic disorder, a cluster B Axis II disorder, a history of homelessness, and use of heroin and/or cocaine. Our results indicate that the risk of readmission is above all an attribute of the patient's illness rather than a feature of the service provided.

Keywords:

• dual diagnosis
• integrated dual diagnosis treatment (IDDT)
• assertive community treatment (ACT)
• outpatient treatment
• aftercare
• hospitalization

Acknowledgement

This study was partly financed by ZonMw, project number: 985-1-019.