Using Data Linkage to Identify Predictors of Care Home Entry After Psychiatric Hospital Discharge: A Retrospective Cohort Study

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B Hickey1; J K Burton2; G Ciminata3; E L Sampson4,5; E B Mukaetova-Ladinska6,7; L Beishon1,8,9
1. Division of Cardiovascular Sciences, University of Leicester; 2. School of Cardiovascular & Metabolic Health, University of Glasgow; 3. School of Health & Wellbeing, University of Glasgow; 4. Academic Centre for Healthy Ageing, Barts Health NHS Trust.
Scientific Research
SP - Big Data
Care Home Medicine

Abstract

Background

Pathways into care homes represent a critical yet under-researched aspect of decision-making for individuals, families, and professionals. Prior research links recent psychiatric hospital discharge to higher risk of care home entry from hospital. This retrospective cohort study used linked health and care home data to identify predictors of care home admission following psychiatric hospital discharge within the previous six months.

Methods

We included adults moving-in to care homes between 1/4/13 and 31/3/16, recorded in the Scottish Care Home Census. Data were linked to inpatient stays, community prescribing, and mortality records to identify diagnoses, comorbidities, polypharmacy, frailty, healthcare use, and deaths. Regression models identified predictors of care home entry following recent (within six months) psychiatric hospital discharge compared to those without.

Results

Following adjustment, individuals entering a care home after a recent psychiatric hospital discharge were more likely to be male (OR 1.60, 95%CI 1.43-1.78), have a diagnosis of any fracture within the past three years (OR 1.90, 95%CI 1.48-2.44), or a dementia diagnosis within the past six months (OR 1.31, 95%CI 1.11-1.55). Furthermore, combined psychiatry and hospital diagnoses three years before moving-in of delirium (OR 1.75, 95%CI 1.38-2.21), dementia (OR 9.05, 95%CI 7.51-10.91), depression (OR 3.97, 95%CI 3.29-4.79), or mental and behavioural disorders due to alcohol (OR 2.10, 95%CI 1.71-2.58) were significant predictors of moving-in to a care home after a psychiatric hospital admission.

Conclusions

This study identifies important differences in the individuals entering care homes after a psychiatric hospital discharge compared to those with non-psychiatric backgrounds. These provide useful insights to a complex clinical population which can guide more supportive practices. Further exploration involving staff, carers, and patients could help shape more informed pathways from psychiatric settings into care homes.

Comments

Thank you for this interesting poster. It is great to see routinely collected data being used to answer important research questions. In particular I can see your findings being used to inform the planning of discharge and social care services for those coming from inpatient psychiatric care.

I was wondering why you chose to use data from the Scottish Care Home Census between 1/4/13 and 31/3/16. As I understand it, it is an annual census. Has the data recorded in the census changed which means it can no longer answer your research question or is there another reason for not using more recent census results?

Submitted by liamljones93 on

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Thank you very much for taking the time to read our poster and share your valuable comment. The study presented here is a secondary analysis of the Understanding Pathways into Care Homes using Data (UnPiCD) study. Therefore, we have used data from the same time frame as that original work. We agree that examining more recent census results would be extremely valuable, and we have highlighted this as a recommendation for future research. We are currently in the process of publishing these findings in a paper, where this point is discussed in greater detail.