New Hampshire Hospital Readmission Project
Over the past several years, there has been an increasing recognition of the limitations of NH's system of services for mental health care. The Ten Year plan highlighted many of these challenges and identified a range of resources that would be helpful towards improving the capacity and effectiveness of the mental health system. As the state has struggled financially and politically to implement these resources, there has been a growing alarm over the increased incidence of waiting lists at area emergency departments. Additionally, legal action taken both nationally and locally suggests that specialized hospitalization and nursing home care occurs too frequently and does not enable individuals to live and receive care in a least restrictive environment.
In light of the growing interest in making a meaningful change to our mental health care system, particularly for those who are most in need of a change in services, the Institute on Disability and NH Hospital have agreed to embark on this joint research effort to help fill in some of the gaps in knowledge that impede the state's ability to provide a more effective care environment for patients. Major questions that we seek to address include:
- How do re-admission rates for mental illness vary by key factors across different hospital settings (Specialty, Inpatient, ER)? Factors include issues such as current abuse of substances, specific mental illness type, length of stay, disposition, ER utilization, payor status, and length of time to readmission. Data Source: Analysis of Hospital Discharge Data
- How does data on re-hospitalization compare to other State hospitals and with our own benchmarks? Data Source: Review of state and national level data resources and literature on re-hospitalization
- What socio-economic factors might increase or decrease the likelihood of readmission to NHH? What kinds of services were patients receiving prior to their last admission? What factors contributed to their last admission? How helpful were the services received at NHH? Were they involved in their treatment? What services do they think would be most helpful to them? What was their service experience after discharge? Did they get access to the services they needed? If no, why not? Data Source: NHH Patient Surveys
- Are any factors related to program participation at NHH which predict differences in readmission rates? Data Source: Review of NHH Administrative Data, NHH Patient Surveys
Our focus on patients at NH Hospital is due to two reasons: 1) by working with this population, we are more likely to be able to draw on the perspectives of those who are most in need of higher levels of care and/or have the most functional limitations imposed by their mental illness and 2), thanks to the effective working partnership that has been established between the IOD and NHH, we will be able to assist NH Hospital in evaluating potential differences in outcomes between those who have received certain interventions at the hospital in the past (Conditional Discharge) versus those who have not.
The project is guided by an Advisory Board, made up of members from the Community Mental Health Centers, NH Hospital Staff, Bureau of Behavioral Health, NAMI NH and other nonprofit and advocacy organization involved in the mental health field.