Isidore Sample PPT Design

The Relationship Between Discharge Planning and Psychiatric Hospital Readmission Rate
Prepared by: Naiga Dohnji

7/23/2011 The Relationship Between Discharge Planning and Psychiatric Hospital Readmission Rate 1
Outline
1. 2. 3. 4. Introduction. Background. Purpose. Method:
Literature review. Research Design Population and sample. Protection of human subjects. Data collection. Data analysis.
5. Discussion. 6. Applicability. 7. Limitations. 8. Conclusion and Recommendations. 9. Appendix A 10.Question?

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1. Introduction
Psychiatric readmissions:

Increased with negative outcomes. Rate/year post-discharge is approx. 40% to 50%. Availability of services, Quality, and Continuity of care.
Factors influencing readmission:
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1. Introduction
(Continued )
Different patient problems after discharge:

Dependence on others. Difficulty obtaining medicationlack of insurance. Failure to obtain help. Lack of awareness of available social programs. Emotional problems: Anxiety and Uncertainty.
The Discharging is not always a smooth process.
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1. Introduction
(Continued )
Patient - Problems during first week post discharge. Comprehensive discharge planning Ensuring outpatient care.
Duration of stay in the hospital has decreased dramatically during the past decades from 6.5 days in 1985 to 4.8 days in 2003.
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2. Background Information
Mental Health: Shifted from institutionalization to the community. Short In-patient stay during acute episodic breaks. Poor outcomes from transition. Only about 50% - Continuation of care. Increase in readmission rate from 24% to 37% per discharge year.
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2. Background Information
(Continued )
A smooth transition from hospital to community requires:

Close cooperation among patients their families, and Community-based agencies.
Lack of support after discharge from psychiatric hospital. 26.2% of Americans 18+ have some form of diagnosable disorder. Reported by Health (NIMH). Greatest among:

Elderly Racial-ethnic minorities The poor The uninsured Those in rural settings
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3. Purpose (Research Question)

Relationship between Comprehensive Discharge Planning and Readmission into psychiatric hospital. Research Question?
Is there a relationship between readmission and discharge planning in the in-patient psychiatric hospital?
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4. Method
Method:
Literature review. Retrospective chart review. Correlation study. Population and sample. Protection of human subjects. Data collection. Data analysis.
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4. Method Literature Review

Method:
A. Literature review:
i. Discharge Planning from a consumers perspective. ii. Admission, Discharge, and Readmission. iii. Follow-up appointment compliance/noncompliance. iv. Timely outpatient visits after discharge. v. Patients with serious mental illnesses. vi. Summary.
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i. Discharge Planning from a consumers perspective
Community services. Meeting with a care team to discuss upcoming discharge. Having the opportunity to participate in counseling. Having family and friends to participate in their care.
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ii. Admission, Discharge, and Readmission
Study by Kottsieper (2006) - Best practices for effective discharge:

Information sharing/communication. Medication management. helper-helpee relationships. adhering to discharge plans and appointments.
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iii. Follow-up appointment compliance/noncompliance
Most important predictors of readmission:

Missing follow-up outpatient appointments.
Missed more often were:

Subjects with a primary substance-related syndrome . Uninsured patients. Those who were not previously involved with their aftercare providers.
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iv. Timely outpatient visits after discharge
High readmission rates:

Patients with failed outpatients appointments attendance (less than two months after discharge).
Timely outpatient visits (shortly after discharge) may be associated with a decreased risk of readmissions.
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v. Patients with serious mental illnesses
Schizophrenia and bipolar disorders:

Higher readmission rate than depression and substance abuse disorder.
To reduce the amount of readmissions:

Longer initial hospitalization stay.
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vi. Summary
Positive correlation between continuity of care and better patient outcomes (including fewer readmissions). Key component of discharge planning:

Continuity of care. Follow-up appointments. Referrals to out-patient therapists and services. Medication plans and prescriptions.
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4. Method Research Design

Correlation study. Retrospective chart review.
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4. Method Population and Sample

Records of adult psychiatric patients readmitted after six months post discharge who received a comprehensive discharge plan and follow up appointments would have been compared with psychiatric patient's records that did not receive a comprehensive discharge plan at time of discharge.
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4. Method Protection of Human Subjects

Confidentiality would have been maintained throughout the study. Permission from the universitys Institutional Review Board (IRB) and hospital access to data would have been obtained. Data would be locked in file-drawer and be destroyed after a period of two years.
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4. Method Data Collection

A check-off list would have been accessed through the patients chart. Data would have been collected using a tally sheet, which indicates whether the patient was readmitted and whether that patient received discharge planning following the check off list.
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4. Method Data Analysis

Data analysis and quality assessment would have been performed using a discharge checklist from the hospital. The charts would have been prescreened following the discharge (Appendix A) and the results would have been used to determine if there is any relationship with incomplete discharge.
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. Discussion
The project might have found:
1) A relationship between patients with a comprehensive discharge planning who had their entire checklist met at time of discharge were less likely to be readmitted within six months post discharge. 2) No relationship between patients with a comprehensive discharge planning who had their entire checklist met at time of discharge were less likely to be readmitted within six months post discharge.
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. Discussion
(Continued )
3) It was also mentioned that readmission of patients back into the hospital are not only a costly alternative but it is also step backward in the patients treatment. 4) The results of the studies have been found to be contradictory in the sense that, length of stay has been mentioned to be a predictor of readmission, whereas others researcher have reported that it is not a factor in readmission. 5) Effective discharge planning can reduce the readmission rate in hospitals.
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6. Applicability
While controlling the cost of health care services, performance monitoring has become an important tool.
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7. Limitations
While controlling the cost of health care services, performance monitoring has become an important The study would be conducted in one hospital so cannot be generalized to the population. Better results might be obtained from using a population of the entire US. This would increase demographic data and possibly yield a higher return rate.
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8. Conclusion and Recommendations

Conclusion:
Proper discharge planning may be one strategy to protect against early readmission and preparing the patients emotionally to manage in the community, with appropriate aftercare supports. Literature analysis supported the idea of a positive correlation between continuity of care and better patient outcomes, including fewer readmissions.
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8. Conclusion and Recommendations

(Continued )
Recommendations:
The study should be repeated with a larger number of patients to increase the validity of this research. Using other psychiatric hospitals is recommended in order to increase the population size, as well as to incorporate a more diverse population.
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9. Appendix A
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10. Questions
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END
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The Relationship Between Discharge Planning and Psychiatric Hospital Readmission Rate

Prepared by: Naiga Dohnji

5. Discussion. 6. Applicability. 7. Limitations. 8. Conclusion and Recommendations. 9. Appendix A 10.Question?

 Factors influencing readmission:

 Different patient problems after discharge:

 The Discharging is not always a smooth process.

 A smooth transition from hospital to community requires:

3. Purpose (Research Question)

4. Method Literature Review

4. Method Literature Review

4. Method Literature Review

 Study by Kottsieper (2006) - Best practices for effective discharge:

4. Method Literature Review

 Most important predictors of readmission:

 Missed more often were:

4. Method Literature Review

 High readmission rates:

4. Method Literature Review

 To reduce the amount of readmissions:

4. Method Literature Review

4. Method Research Design

4. Method Population and Sample

4. Method Protection of Human Subjects

4. Method Data Collection

4. Method Data Analysis

8. Conclusion and Recommendations

8. Conclusion and Recommendations

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Factors influencing readmission:

Different patient problems after discharge:

The Discharging is not always a smooth process.

A smooth transition from hospital to community requires:

Study by Kottsieper (2006) - Best practices for effective discharge:

Most important predictors of readmission:

Missed more often were:

High readmission rates:

To reduce the amount of readmissions: