Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias
Abstract Objectives Cost containment and quality of care considerations have increased research interest in the potential preventability of early re‐hospitalisations. Various registry‐based retrospective cohort studies on psychiatric re‐hospitalisation have focused on the role of early post‐discharg...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | International Journal of Methods in Psychiatric Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/mpr.1983 |
| _version_ | 1797238987160551424 |
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| author | H. Katschnig C. Straßmayr F. Endel M. Posch I. Steiner |
| author_facet | H. Katschnig C. Straßmayr F. Endel M. Posch I. Steiner |
| author_sort | H. Katschnig |
| collection | DOAJ |
| description | Abstract Objectives Cost containment and quality of care considerations have increased research interest in the potential preventability of early re‐hospitalisations. Various registry‐based retrospective cohort studies on psychiatric re‐hospitalisation have focused on the role of early post‐discharge service contacts, but either did not consider their time‐dependent nature (‘immortal time bias’) or evaded the issue by analysing late re‐hospitalisations. The present study takes care of the immortal time bias in studying early psychiatric re‐hospitalisations. Methods In a retrospective cohort study using nationwide electronic claims data in Austria, 10,689 adults discharged from acute psychiatric inpatient wards were followed up for 30 days. Cox regression analyses were performed with post‐discharge psychiatric and general practitioner contacts as time‐dependent covariates and time to first psychiatric re‐hospitalisation as outcome. Results Post‐discharge ambulatory physician contacts were significantly associated with a decreased psychiatric re‐hospitalisation rate (hazard ratio 0.77 [95% CI 0.69; 0.87], p < 0.0001), with similarly strong contributions to this association by general practitioners and psychiatrists. Conclusions Despite avoiding the immortal time bias and controlling for several confounders, we suggest to be cautious with a causal interpretation of the identified association, since potentially relevant confounders, such as disease severity, were unavailable in our claims data base. |
| first_indexed | 2024-04-24T17:44:22Z |
| format | Article |
| id | doaj.art-ce315f107825405a9224a3849bc9bf21 |
| institution | Directory Open Access Journal |
| issn | 1049-8931 1557-0657 |
| language | English |
| last_indexed | 2024-04-24T17:44:22Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Methods in Psychiatric Research |
| spelling | doaj.art-ce315f107825405a9224a3849bc9bf212024-03-27T15:10:42ZengWileyInternational Journal of Methods in Psychiatric Research1049-89311557-06572024-03-01331n/an/a10.1002/mpr.1983Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time biasH. Katschnig0C. Straßmayr1F. Endel2M. Posch3I. Steiner4Department of Psychiatry Medical University of Vienna Vienna AustriaIMEHPS.research Vienna AustriaIMEHPS.research Vienna AustriaMedical University of Vienna Center for Medical Data Science Institute of Medical Statistics Vienna AustriaMedical University of Vienna Center for Medical Data Science Institute of Medical Statistics Vienna AustriaAbstract Objectives Cost containment and quality of care considerations have increased research interest in the potential preventability of early re‐hospitalisations. Various registry‐based retrospective cohort studies on psychiatric re‐hospitalisation have focused on the role of early post‐discharge service contacts, but either did not consider their time‐dependent nature (‘immortal time bias’) or evaded the issue by analysing late re‐hospitalisations. The present study takes care of the immortal time bias in studying early psychiatric re‐hospitalisations. Methods In a retrospective cohort study using nationwide electronic claims data in Austria, 10,689 adults discharged from acute psychiatric inpatient wards were followed up for 30 days. Cox regression analyses were performed with post‐discharge psychiatric and general practitioner contacts as time‐dependent covariates and time to first psychiatric re‐hospitalisation as outcome. Results Post‐discharge ambulatory physician contacts were significantly associated with a decreased psychiatric re‐hospitalisation rate (hazard ratio 0.77 [95% CI 0.69; 0.87], p < 0.0001), with similarly strong contributions to this association by general practitioners and psychiatrists. Conclusions Despite avoiding the immortal time bias and controlling for several confounders, we suggest to be cautious with a causal interpretation of the identified association, since potentially relevant confounders, such as disease severity, were unavailable in our claims data base.https://doi.org/10.1002/mpr.198330‐day readmissionambulatory caregeneral practitionerimmortal time biaspsychiatric hospital department |
| spellingShingle | H. Katschnig C. Straßmayr F. Endel M. Posch I. Steiner Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias International Journal of Methods in Psychiatric Research 30‐day readmission ambulatory care general practitioner immortal time bias psychiatric hospital department |
| title | Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias |
| title_full | Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias |
| title_fullStr | Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias |
| title_full_unstemmed | Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias |
| title_short | Are early post‐discharge physician contacts associated with 30‐day psychiatric re‐hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias |
| title_sort | are early post discharge physician contacts associated with 30 day psychiatric re hospitalisation a nationwide claims data based retrospective cohort study in austria free of immortal time bias |
| topic | 30‐day readmission ambulatory care general practitioner immortal time bias psychiatric hospital department |
| url | https://doi.org/10.1002/mpr.1983 |
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