DETERMINANTS OF READMISSION FOLLOWING INPATIENT SUBSTANCE-ABUSE TREATMENT - A NATIONAL STUDY OF VA PROGRAMS

This study examines program determinants of one aspect of VA inpatient substance abuse treatment program performance. Performance was measur ed by the ratio of a program's readmission rate to the expected rate f or programs with similar patients. Six-month readmission rates in 101 VA treatment programs were analyzed. Preliminary analyses indicated th at patient differences across programs accounted for 36% of the varian ce in readmission rates. Program differences accounted for 47% of the variance in case-mix-adjusted readmission rate. Among program factors selected through a literature review, better than expected readmission performance was associated with having fewer early discharges, a long er intended treatment duration, more patient participation in aftercar e, more family or friend assessment interviews, and treating more pati ents on a compulsory basis. Performance was not related to stress mana gement training, patient attendance at more self-help meetings during treatment, staff characteristics, or average staff costs per patient d ay. The findings indicate that treatment retention, duration, and incr eased aftercare may be targeted to reduce high readmission rates. Last , there were only small differences in the model over 30, 60, 90, and 365 day follow-up intervals, suggesting substantial stability of the f indings.