A study on the quality of care in psychiatric patients: Focused on the effect of continuity of care

Abstract

Background: The socioeconomic burden of mental illness is increasing worldwide, and similar to other developed countries, the burden is expected to increase further in Korea. In addition to the increased burden, Korea has a poorer quality of mental health care than other Organization for Economic Cooperation and Development (OECD) countries, as evidenced by re-admissions and suicides after hospital discharge. To improve the quality of care of persons who are mentally ill, the OECD recommends continuing care after discharging them from the hospital, and in studies conducted outside of Korea, continuity of care has been reported to have positive effects on health outcomes However, this association has not been established in psychiatric studies. There is a lack of research on continuity of post-discharge care in South Korea and improved quality of care. Therefore, this study sought to clarify the relationship between continuity of care after hospitalization for a mental illness and quality of care.

Methods: This study used data from the National Health Insurance Service-Cohort Sample from 2002 to 2013. The study’s participant was limited to 18,702 psychiatric inpatients. The dependent variables were readmission, all-cause mortality, and suicides within 1 year ost-discharge. A nested case-control study design was used because of the immortal time bias that can occur in measuring continuity of ambulatory care, due to the different follow-up times of individuals within the observation period. Thus, all cases consisted of persons with a mental illness who were readmitted to the hospital (n = 8,022), died (n = 355), or committed suicide within 1 year after hospital discharge (n = 108). For readmission cases, up to one control (or ten controls for all-cause mortality or suicide cases), was randomly extracted from the risk set and matched by follow-up time and year of discharge. The index date was defined as the date on which the event occurred. Continuity of psychiatric outpatient care was measured from the time of hospital discharge until readmission or death occurred (or the index date for the control group). Conditional logistic regression was conducted to estimate the odds ratio (OR) for continuity of care, adjusting for sociodemographic, treatment, and hospital factors.

Results: Of the 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 who had a high continuity-of-care score, a significant increase in the risk of readmission within 1 year after hospital discharge was found in those with medium (OR 1.519 95% CI 1.250–1.845) and low (OR 1.769 95% CI 1.425–2.263) continuity-of-care scores. An increased risk of all-cause mortality within 1 year after hospital discharge was found in the patients in the low continuity group (OR 3.118 95% CI: 1.592–6.106), relative to those in the high-continuity group. The risk of suicide within 1 year after hospital discharge was higher in those with medium (OR 2.709 95% CI: 1.168–6.284) and low continuity of care (OR 3.839 95% CI: 1.351–10.914) than those with high continuity of care.

Conclusion: This study found that better continuity of outpatient care after psychiatric hospitalization improved quality of care, as measured by re-admissions, deaths from all causes, and suicides. Therefore, 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.