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Early readmission to psychiatric units poses a significant challenge for both patients with mental health issues and healthcare institutions. It hampers patient progress and prognosis, and the professional approach taken during discharge can greatly influence the recovery process. This paper proposes a multicomponent discharge transition intervention to mitigate the risk of early readmission to a Mental Health Hospitalization Unit (MHHU).
The intervention entails developing a measurement scale to assess patients' risk of early readmission, allowing for stratification into high, medium, and low-risk categories. Tailored intervention strategies will focus on ensuring adherence and continuity of care post-discharge, with a more comprehensive approach for high-risk patients. Additionally, a post-discharge psychotherapeutic group will be incorporated for high-risk cases to support recovery. The efficacy of the program will be analyzed by comparing the overall early readmission risk at the Regional Hospital of Malaga's MHHU with the previous year, using admission episodes from two other hospitals in the province as a control group where the intervention program is not implemented. The success of the post-discharge group psychotherapeutic intervention will be evaluated through pre-post assessments of recovery measures, functionality, subjective well-being, social support, and treatment satisfaction.
This proposal aims to address the issue of early readmission to psychiatric units by enhancing predictability and understanding of intervention strategies to reduce readmission rates.
The aim of this study is, firstly, to create a tool for assessing the risk of early readmission that allows for stratification of admitted patients according to their risk level, based on the analysis of clinical and sociodemographic variables. The second objective is to implement an intervention program tailored to each risk level, involving coordination among all involved mental health units and a specific intensive program for patients at higher risk.
The present study is a quasi-experimental cluster clinical trial aimed at assessing the efficacy of a multicomponent discharge transition program for the reduction of early readmissions in a MHHU. The development of this study consists of two distinct parts or elements:
To carry out the main objective, a quasi-experimental design with a control group will be used, and within the intervention, an early readmission risk assessment scale will be created to categorize patients into different risk levels.
In addition, a study will be conducted to assess the predictive value and validity of the early readmission risk rating scale and to study the risk factors for early readmission.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | The intervention program is based on the Discharge Transition Model for the prevention of hospital readmission in Mental Health. This is a multicomponent program that initially involves the development of a scale to assess the risk of readmission for each patient, followed by its systematic application. This allows for stratification of patients according to their risk of early readmission and adaptation of the intervention to the needs of each risk level. The intervention includes elements aimed at promoting continuity of care after discharge, transitioning back to the community setting, as well as elements aimed at enhancing personal and emotional resources through psychotherapeutic approaches. |
|
| Control group I | No Intervention | To assess the effectiveness of the Multicomponent Discharge Transition Program, users from Málaga East Axarquía Hospital and North Málaga Health Management Area will be employed as the control group. Participants in the control group will continue with their usual treatment. | |
| Control group II | No Intervention | Additionally, users from the Mental Health Management Unit of Regional Hospital of Málaga who were admitted the previous year and thus did not participate in the intervention program will also be used as a control group. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transitional discharge program | Behavioral | For patients classified in the low-risk group, general measures would be applied. For patients in the medium-risk group, reinforced measures would be implemented. Lastly, for patients considered to be in the high-risk group, intensive case management measures would be applied, and if they meet the inclusion criteria, they would be included in the Post-Discharge Group Psychotherapeutic Intervention.
|
| Measure | Description | Time Frame |
|---|---|---|
| Early readmission rate | Changes in the percentage of early readmissions over the total number of recorded admission episodes, considering early readmission as any admission episode that occurs within 30 days after hospital discharge. | Data will be collected over the 12 months following the implementation of the intervention program. |
| Measure | Description | Time Frame |
|---|---|---|
| Recovery | Changes in measures of recovery, will be assessed through pre-post administration of the QPR-15-SP questionnaire. | Five months between pre and post evaluation |
| Functionality | Changes in measures of functionality, will be assessed through pre-post administration of the PSP questionnaire. |
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Inclusion Criteria:
Exclusion Criteria:
• Users belonging to other hospitals in the province will be excluded from the intervention program and will form part of the control group.
Post-Discharge Group Psychotherapy Support Recovery has its own eligibility criteria:
Inclusion criteria:
Exclusion criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Vera Carbonell Aranda, Bachelor | Contact | 695992369 | vera.caar@hotmail.com | |
| José Guzmán Parra, Doctor | Contact | 951290307 | jose.guzman.parra.sspa@juntadeandalucia.es |
| Name | Affiliation | Role |
|---|---|---|
| Vera Carbonell Aranda, Bachelor | Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Vera Carbonell Aranda | Recruiting | Málaga | 29009 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31760955 | Background | Tyler N, Wright N, Waring J. Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis. BMC Health Serv Res. 2019 Nov 25;19(1):883. doi: 10.1186/s12913-019-4658-0. | |
| 26804775 | Background | Donisi V, Tedeschi F, Salazzari D, Amaddeo F. Pre- and post-discharge factors influencing early readmission to acute psychiatric wards: implications for quality-of-care indicators in psychiatry. Gen Hosp Psychiatry. 2016 Mar-Apr;39:53-8. doi: 10.1016/j.genhosppsych.2015.10.009. Epub 2015 Nov 1. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Mar 20, 2023 | Apr 12, 2024 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D001523 | Mental Disorders |
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|
| Five months between pre and post evaluation |
| Subjective well-being | Changes in measures of subjective well-being, will be assessed through pre-post administration of the Core-Om questionnaire. | Five months between pre and post evaluation |
| Satisfaction with treatment | Changes in measures of satisfaction with treatment, will be assessed through pre-post administration of the CAT questionnaire. | Five months between pre and post evaluation |
| Perceived social support | Changes in Perceived social support will be assessed through pre-post administration of the DUKE-UNK questionnaire. | Five months between pre and post evaluation |
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