PREDICTING REVOLVING-DOOR PATIENTS IN A 9-YEAR NATIONAL SAMPLE

We attempted to predict revolving door (RD) patterns of admission (fou r or more admissions with less than 2.5 years between consecutive admi ssions) in a random sample of 10% of all first admissions to psychiatr ic hospitals and psychiatric wards of general hospitals in Israel from 1983 to 1990 with follow-up into 1993. This included 4570 hospitaliza tions of 2220 patients. Data were extracted from the National Psychiat ric Case Registry of the Ministry of Health. Almost 59% of the sample had only one admission, 41% had two or more, 23% had three or more, an d 14% had four or more admissions. Patients with four or more admissio ns were all RD patients. They had an average of 200 days between admis sions. The average number of admissions for RD patients was 6.17, and the average number of years between the first admission and the last a dmission was 3.28 years. Using discriminant analysis we correctly pred icted 73.9% of the non-RD group (about chance level since 80% of the c ases were non-RD) and 71.2% of the RD group (considerably better than chance, only 12.0% of the sample were RD). The main predictors of RD i n descending order were not being married at the time of first hospita lization, unemployment and more severe initial diagnosis. The minor pr edictors were older age, more education and longer first admission. Su bstance abuse, patients ability to care for their affairs, voluntary s tatus of first admission and suicide attempts did not predict RD. The predictors of RD were almost the same as predictors of more than one a dmission. We were not able to identify a variable that clearly differe ntiated between the two or more, three or more and four or more admiss ions groups. Variability between hospitals is also presented.