Applicant Name: Martin Rotenberg
Supervisor Name: Dr. Paul Kurdyak
Amount Awarded: $65,000
Title: Geographic and social factors and the risk of readmission following initial hospital admission for schizophrenia in Ontario: A retrospective population based cohort study
Abstract:
Introduction: Geographic and social factors are associated with the incidence of schizophrenia and health service use, however, there is a dearth of data on how these factors impact outcomes. There is only one prior study from Taiwan that examined geographical factors and readmission rates for schizophrenia, however, confounders including the level of outpatient care, severity, marginalization and other social factors were not considered. Objective: To examine the relationship between geography, social factors, and care outcomes in people with schizophrenia. We hypothesize that people who are admitted to hospitals further away from their homes and areas with greater levels of marginalization are more likely to be readmitted.
Methods: A retrospective cohort identifying all index hospitalizations for schizophrenia in Ontario (2009-2019) will be constructed from administrative health data. The primary exposure of interest— distance—will be calculated using drive time analysis between hospitals and residential addresses. Covariates including medical comorbidity, immigration status, severity, length of stay, outpatient care, injectable medication, rurality and marginalization will be obtained. Cox proportional hazard models will estimate hazard ratios of readmission within 30 and 180 days of discharge. Outcomes: The findings of this study may inform clinical practice and be used by policymakers to improve service planning and outcomes. This cohort will also be used to assess outcomes associated with Health Quality Ontario care standards, and as a baseline ‘population at risk’ to further analyze spatial accessibility of specialized mental health services including Early Psychosis Intervention programs and Assertive Community Treatment Teams across Ontario.