CEPHOS-LINK Final Conference

1. 22.8.2017 1
Psychiatric readmission –
making sense of differences
from the Finnish perspective
Peija Haaramo, Kristian Wahlbeck, Johanna Cresswell-Smith
CEPHOS-LINK Final Seminar, 23.3.2017, THL, Helsinki
This project has received funding from the European Union’s Seventh Framework Programme
for research, technological development and demonstration under grant agreement no 603264

2. Finnish data used in the study
• Data sources:
• THL: Care Register for Health Care (Hilmo), specialised health care visits
and inpatient care
• THL: Register of Primary Health Care Visits (AvoHilmo), outpatient visits
in primary health care
• Statistics Finland: deaths (Causes of death registry) and socioeconomic
factors
• Time:
• Index year 2012, one-year follow-up starting from the first hospital
discharge

3. Data flow-chart: from Hilmo to CEPHOS-LINK
study cohort
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Hilmo: separations from hospitals
2012 (no military/prison/forensic)
N= 963 646
Aged ≥ 18
N= 900 862
”Real” discharges
N= 621 933
ICD-10 main diagnoses, class F
N= 49 836
ICD-10 main diagnoses, F2-F6
N= 24 764
Treated within psychiatric
specialities
N= 20 131
Finnish study cohort
N= 16 814
Excluded: no treatment
within psychiatric
specialities
Included: based on the first
hospital episode in 2012
Excluded: other class
F diagnoses than F2-F6
Excluded: other than
ICD-10 class F diagnoses
Excluded: deaths, transfers
between hospitals
Excluded: age <18
Episodes
Patients

4. CEPHOS-LINK study cohorts
Country
(baseline year)
Population
18+
Psychiatric beds
(per 1 000
population)
Study cohorts
Absolute
‰ of population
18+
% of patients
who died during
the 1-year
follow-up
Austria (2006) 6 667 764 0.61 21 839 3.28 2.60
Finland (2012) 4 333 723 0.69 16 814 3.88 2.40
Italy (2012) 49 396 435 0.10 63 419 1.28 Not known
Norway (2012) 3 898 012 1.21 17 158 4.40 1.38
Romania (2012) 16 254 443 0.82 101 834 6.24 Not known
Slovenia (2013) 1 702 827 0.66 4 536 2.66 2.31
All countries 82 253 204 225 600 2.74 Not known
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From: Katschnig et al. (2017) CEPHOS-LINK: Local re-hospitalisation studies for six European countries (not published)

5. Country comparison: gender and age
46 45
48
42
53
49
42 42
44
41
51
43
0
10
20
30
40
50
60
AT
N=13.053 (female)
N=8.786 (male)
FI
N=9.312 (female)
N=7.502 (male)
IT
N=32.610 (female)
N=30.809 (male)
NO
N=10.082 (female)
N=7.076 (male)
RO
N=61.424 (female)
N=40.410 (male
SI
N=2.473 (female)
N=2.063 (male)
Median age of patients by gender
female male
From: Katschnig et al. (2017) CEPHOS-LINK: Local re-hospitalisation studies for six European countries (not published)
Years

6. 0
5
10
15
20
25
30
35
Finland Norway Austria Italy Romania Slovenia
Country comparison: median length of stay
From: Katschnig et al. (2017) CEPHOS-LINK: Local re-hospitalisation studies for six European countries (not published)
(N=16 814) (N=17 158) (N=21 839) (N=63 419) (N=101 834) (N=4 536)
Days

7. Finnish cohort: diagnostic distribution, year
2012 (N=16 814)
Main diagnosis Number %
Psychotic vs
non-psychotic, %
F2 Schizophrenia 7 363 43.8
56.4
F30-F31 Bipolar 2 122 12.6
F32-F39 Depression 4 909 29.2
43.6
F4 Anxiety etc. 1 642 9.8
F5 Psychosomatic 256 1.5
F6 Personality disorder 522 3.1
Total 16 814 100.00 100.00
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8. Country comparison: psychotic diagnoses
22.8.2017 Esityksen nimi / Tekijä 8
36,2%
56,4%
60,6%
39,3%
37,2%
51,8%
0%
10%
20%
30%
40%
50%
60%
70%
AT
N=21.839
FI
N=16.814
IT
N=63.419
NO
N=17.158
RO
N=101.834
SI
N=4.536
Percentage of patients with a
psychotic diagnosis
From: Katschnig et al. (2017) CEPHOS-LINK: Local re-hospitalisation studies for six European countries (not published)

9. Country comparison: psychiatric readmission
From: Katschnig et al. (2017) CEPHOS-LINK: Local re-hospitalisation studies for six European countries (not published)

10. Country comparison: psychiatric readmission,
30 days and one year
0
10
20
30
40
50
60
Finland Austria Italy Norway Romania Slovenia
30 days
365 days
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%
From: Katschnig et al. (2017) CEPHOS-LINK: Local re-hospitalisation studies for six European countries (not published)
N=16 814 N=21 839 N=63 419 N=17 158 N=101 834 N=4 536

11. Country comparison: any readmission,
30 days and one year
0
10
20
30
40
50
60
Finland Austria Italy Norway Romania Slovenia
30 days
365 days
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%
From: Katschnig et al. (2017) CEPHOS-LINK: Local re-hospitalisation studies for six European countries (not published)
N=16 814 N=21 839 N=63 419 N=17 158 N=101 834 N=4 536

12. Finland: age and the risk of one year psychiatric
readmission (%), years 2012-2013 (N=16 814)
0
5
10
15
20
25
30
35
40
45
18-30 31-40 41-50 51-60 61-70 71-80 81+
Women
Men
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%
Age

13. Hospital districts: one year
psychiatric readmission,
years 2012-2013 (N=16 814)
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28-32%
33-37%
38-42%
43-47%
48+ %
Readmission rate:
Whole country: 39.9%
(Range: 28-54%)

14. Hospital districts: psychiatric readmissions in
30 and 365 days
0
10
20
30
40
50
60 30 days
365 days
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%

15. Hospital districts:
non-planned (re)admissions,
years 2012-2013 (N=16 814)
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59-66%
67-74%
75-82%
83-90%
91+ %
Whole country: 78%
(range: 59-100%)
Psychiatric readmissions, share of
non-planned admissions:

16. Hospital districts:
involuntary admissions,
year 2012 (N=16 814)
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10-18%
19-26%
27-34%
35-42%
43+ %
Whole country: 26%
(Range: 10-51%)
Share of involuntary admissions:

17. Hospital districts: median length of stay,
year 2012 (N=16 814)
0
5
10
15
20
25
30
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Days

18. Hospital districts: psychotic diagnoses (%),
year 2012 (N=16 814)
0
10
20
30
40
50
60
70
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%

19. 22.8.2017 Esityksen nimi / Tekijä 19
OR
LoS, days
0
0,5
1
1,5
2
2,5
1-50 51-100 101-150 151+
Psychotic (total risk 43.5%)
Non-psychotic (total risk 35.3%)
Finland: length of stay and risk of one-year psychiatric
readmission among patients with psychotic and non-
psychotic diagnosis, odds ratios (OR) (2012-2013, N=16 814)
Adjusted for age and gender
Ref.: reference group
Ref.

20. Hospital districts: outpatient contact within one week
from discharge, year 2012 (N=16 814)
0
10
20
30
40
50
60
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%
Specialized health care
Primary health care

21. Finland: frequency of outpatient visits as a predictor of
one-year psychiatric readmission (2012-2013, N=16 814)
0
0,5
1
1,5
2
2,5
3
Non-adjusted
Adjusted
Full model adjusted
for age, gender,
LoS, somatic
comorbidity and
diagnosis
Ref.
OR
*
*
*
*
*
*
*
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*
ref. = reference group
* = model statistically significant

22. Conclusions
• Readmission is a valuable health care indicator
• Careful especially if you use it just by itself, many things affect
the interpretations!
• Individual level factors
• System level factors
• Readmission risk and the factors affecting it should be
acknowledged
• On individual level when making tailored individual care plans
• In health care system planning

23. Research use of Finnish health registers –
future?
1)User-friendly & researcher-friendly & decision-maker-friendly health registers
→ more efficient information-based decision making & routine monitoring
(sote!)
2)Integration of social and health care register data for research
3)Needed: occupational health care data also included in the registers
4)Needed: educating the grass root level “data producers” → more uniform
coding practices
5)Needed: better identification of health care units (hospitals, primary care
centres etc.) for easier comparisons
6)The role of Kanta Patient Data Repository in research use?

24. Thank you!
Contact: peija.haaramo@thl.fi