Continuity of Care Association and Readmission to Hospital in Patients With Severe Psychosis

In this 36-month prospective cohort study, “The Association between Continuity of Care and Readmission to Hospital in Patients with Severe Psychosis” (Puntis, Rugkåsa & Burns, 2016), the researchers examine the effectiveness of good continuity of care. The primary objective of this study was to critically examine the service use and a multidimensional concept of continuity of care and their impact on outcomes in patients discharged from mental wards. The secondary objective was to identify key patterns of service use in mental patients. Puntis, Rugkåsa, and Burns (2016) define continuity of care as an approach to delivering care that is seen as comprehensive, consistent, and connected. Even though continuity of care is internationally recognized as an indicator of quality, the researchers report that the evidence on its actual effects is quite scarce.

Puntis, Rugkåsa, and Burns (2016) recruited 336 randomized patients from 32 mental health organizations in southern and central England. The recruitment took place between 2008 and 2011, and the patients were followed up for 36 months. The eligibility criteria included being of age (18-65 years), official psychosis diagnosis, and ongoing involuntary hospital detention. Puntis, Rugkåsa, and Burns (2016) recruited only patients who were able to give informed consent and received approval from the Staffordshire National Health Service (NHS) Research Ethics Committee. Continuity of care was measured using components from the Experiences of Continuity of Care and Health and Social Outcomes study (ECHO). The ECHO put forward an eight-dimension framework that assessed:

  1. therapeutic relationships;
  2. regularity of service;
  3. meeting needs;
  4. consolidation (number of agencies used);
  5. managed transitions;
  6. care coordination; and
  7. supported living.

Patient outcomes were operationalized as readmission to the hospital (binary: yes or no), time to readmission (continuous values), and the number of days in the hospital (continuous values).

Statistical analysis of the collected data was conducted using SPSS software version 20. Puntis, Rugkåsa, and Burns (2016) examined predictor variables and outcome measures for normal distribution and outliers. The associations between dependent and independent variables were identified through regression analyses with adjustment for demographic characteristics such as age, gender, and ethnicity. Puntis, Rugkåsa, and Burns (2016) have found that mental hospitals in England maintain a good level of contact with discharged patients, especially if the turnover rate of staff is low. The researchers have identified a linear relationship between continuity of care and positive patient outcomes.


Puntis, S. R., Rugkåsa, J., & Burns, T. (2016). The association between continuity of care and readmission to hospital in patients with severe psychosis. Social Psychiatry and Psychiatric Epidemiology, 51(12), 1633-1643.