Vigod et al reported the READMIT score to evaluate a patient being discharged from an acute psychiatric hospital. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Canada.
Patient selection: acute psychiatric admission, age >= 18 years
READMIT is a mnemonic
Parameters:
(1) number of previous admissions to index over lifetime
(2) threat to others
(3) threat to self
(4) unable to care for self
(5) age in years
(5) primary diagnosis
(6) any personality disorder
(7) unplanned discharge
(8) Charlson comorbidity index
(9) outpatient psychiatrist visits within past year year
(10) emergency department visits for psychiatric problem within past year
(11) length of stay in days
|
Parameter |
Finding |
Points |
|
previous admissions |
0 |
0 |
|
|
1 or 2 |
2 |
|
|
3 or 5 |
5 |
|
|
>= 6 |
7 |
|
threat to others |
no |
0 |
|
|
yes |
1 |
|
threat to self |
no |
0 |
|
|
yes |
1 |
|
unable to care for self |
no |
0 |
|
|
yes |
2 |
|
age |
18 to 24 years |
8 |
|
|
25 to 34 years |
7 |
|
|
35 to 44 years |
6 |
|
|
45 to 54 years |
5 |
|
|
55 to 64 years |
4 |
|
|
65 to 74 years |
3 |
|
|
75 to 84 years |
2 |
|
|
85 to 94 years |
1 |
|
|
>= 95 years |
0 |
|
primary diagnosis |
alcohol or substance abuse |
0 |
|
|
depression |
2 |
|
|
psychosis or bipolar |
4 |
|
|
other |
3 |
|
any personality disorder |
no |
0 |
|
|
yes |
2 |
|
unplanned discharge |
no |
0 |
|
|
yes |
5 |
|
Charlson comorbidity |
0 |
0 |
|
|
1 or 2 |
1 |
|
|
3 or more |
2 |
|
outpatient psychiatrist |
0 or 1 visit |
0 |
|
|
>= 2 |
2 |
|
ED visits |
none |
0 |
|
|
>= 1 |
3 |
|
length of stay |
<= 14 days |
4 |
|
|
15 to 28 days |
3 |
|
|
>= 29 days |
0 |
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 41
• The higher the score the greater the readmission rate.
|
Score |
Expected Readmissions |
|
0 to 4 |
2% |
|
5 to 7 |
3% |
|
8 to 10 |
4% |
|
11 or 12 |
5% |
|
13 to 15 |
6% |
|
16 or 17 |
8% |
|
18 |
9% |
|
19 |
10% |
|
20 |
11% |
|
21 |
12% |
|
22 |
13% |
|
23 |
14% |
|
24 |
15% |
|
25 |
17% |
|
26 |
18% |
|
27 |
19% |
|
28 |
21% |
|
29 |
23% |
|
30 |
24% |
|
31 |
26% |
|
32 |
28% |
|
33 |
30% |
|
34 |
32% |
|
35 |
35% |
|
36 |
37% |
|
37 |
39% |
|
38 |
41% |
|
39 |
44% |
|
40 |
46% |
|
41 |
49% |
Performance:
• The area under the ROC curve was 0.63.
Purpose: To predict the 30-day readmission rate for a patient being discharged after an acute psychiatric admission using the READMIT score of Vigod et al.
Objective: severity, prognosis, stage
ICD-10: ,
