Behavioral Health Diagnoses Can Inflate Readmissions Rates, Hinder Self-Management

Thursday, April 9th, 2015
This post was written by Cheryl Miller

Preliminary data from a Care Transitions Task Force found that when patients with behavioral health diagnoses are excluded from readmissions rates, those rates fall by nearly 4 percent, says Michelle Schneidermann, MD, task force member and Associate Clinical Professor of Medicine for the division of hospital medicine at the University of California, San Francisco, and Medical Director of the San Francisco Department of Public Health, Medical Respite and Sobering Center. Part of the reason for this is this patient population’s inability to follow through on self-management instructions once they leave the hospital.

Question: Among your discharge patients there’s a number of behavioral health diagnoses. Are there any considerations, or challenges to this patient population during care transitions, and any unique follow-up that your organization is doing?

Response: (Dr. Michelle Schneidermann) Yes, this patient population provides a very distinct challenge. The patients are challenged by so many other competing priorities, in addition to having a significant and severe mental health disorder, that it interferes with their ability to organize and follow through with the self-management requirements we place on them when they leave the hospital and their ability to manage chronic illness in general. So, from the patient perspective, it’s incredibly difficult.

From the systems perspective, although we are an integrated network health system, there are limitations on the number of outpatient behavioral healthcare clinics and providers. Plus, we don’t always have providers who are culturally concordant or language concordant, although the network is trying very hard to make that happen.

One of the things we’re working on right now is to tease out what our readmission rate looks like when we pull out all patients who have a behavioral health code. Just initial, very crude, back of the envelope calculations show a significant difference in our readmission rate.

When patients with behavioral health diagnoses are included, our hospital-wide, 30-day all-cause readmission rate is around 12 percent. When you remove patients with the behavioral health diagnosis, the readmission rate goes down to about 8.5 or 9 percent. Again, preliminary data, but it shows you the impact that this patient population has on readmissions and tells the story about the challenges that they personally face when they’re leaving the hospital.

cross-continuum care transitions
Dr. Michelle Schneidermann completed her primary care internal medicine training at UCSF and joined the UCSF faculty in 2003, where she is a member of the Division of Hospital Medicine at San Francisco General Hospital (SFGH). Through her inpatient clinical work and work with ambulatory programs, she has been able to directly witness the successes and challenges of patients’ transitions and generate feedback to the providers and systems that manage their care.

Source: Cross-Continuum Care Transitions: A Standardized Approach to Post-Acute Patient Hand-Offs

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