Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis

Abstract

Background Pneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis. Methods and findings This national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up. Conclusion Among older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.

Characteristics and Percentage of 30 Days All Cause Hospital Readmissions in Mongolia

“…Authors believe that one out of four patients readmitted within 30 days after discharge from the hospital is preventable [20,21]. In the literature, significant causes leading to readmissions, such as heart failure [7,22], stroke, pneumonia, asthma, chronic obstructive pulmonary disease (COPD), diabetes, and comorbidity [23] diagnoses with surgical procedures [24,25] have been reported.…”

Integration of patient experience factors improves readmission prediction

“…The importance of patient-related factors has been a recent focus of study. Among others, readmission risk has been assessed in terms of discharge disposition, [ 10 ] post-acute care facility usage, [ 11 ] timing, particularly as it relates to skilled nursing facilities, [ 12 ] and physical and occupational therapy administration. [ 13 ] Further, interventions attempting to attenuate readmission have been studied, including the use of community health workers [ 14 , 15 ] and disease-specific interventions.…”

Increasing illness severity of skilled nursing facility patients over time: Implications for readmission penalties

“…Furthermore, the structured implicit medical record review methodology utilized for the studies that shaped the current financial penalty structure led to an overestimation of readmissions labeled as "potentially avoidable" as this statistic included those deemed "probably avoidable" as well as "definitely avoidable." [9][10][11] The Draft Technical Report describes how the SNFRM risk adjusts for variations across SNF's in casemix and patient characteristics. 5…”

“…However, none of the three studies address the baseline illness acuity of the patients in question as a variable possibly affecting readmissions at the level of a single SNF, geographic group of SNFs, or other grouping such as SNFs of a specific size. Furthermore, the structured implicit medical record review methodology utilized for the studies that shaped the current financial penalty structure led to an overestimation of readmissions labeled as “potentially avoidable” as this statistic included those deemed “probably avoidable” as well as “definitely avoidable.” 9–11 …”