Association of continuity of care with readmission, mortality, and suicide after hospital discharge among psychiatric patients.

Choi, Young; Nam, Chung Mo; Lee, Sang Gyu; Park, Sohee; Ryu, Hwang-Gun; Park, Eun-Cheol

OBJECTIVES The objective of this study was to identify the association between continuity of ambulatory psychiatric care after hospital discharge among psychiatric patients and readmission, mortality, and suicide. DESIGN Nationwide nested case-control study. SETTINGS South Korea. PARTICIPANTS Psychiatric inpatients. INTERVENTIONS Continuity of psychiatric outpatient care was measured from the time of hospital discharge until readmission or death occurred, using the continuity of care index. MAIN OUTCOME MEASURES Readmission, all-cause mortality, and suicides within 1-year post-discharge. RESULTS Of 18,702 psychiatric inpatients in the study, 8,022 (42.9%) were readmitted, 355 (1.9%) died, and 108 (0.6%) died by suicide within 1 year after discharge. Compared to the psychiatric inpatients with a high continuity-of-care score, a significant increase in the readmission risk within 1 year after discharge was found in those with medium and low continuity of care scores. An increased risk of all-cause mortality within 1 year after hospital discharge was shown in the patients in the low continuity group, relative to those in the high-continuity group. The risk of suicide within 1 year after hospital discharge was higher in those with medium and low continuity of care than those with high continuity of care. CONCLUSION This study's results provide empirical evidence of the importance of continuity of care when designing policies to improve the quality of mental health care, such as increasing patient awareness of the importance of continuity and implementation of policies to promote continuity.