Early Hospital Readmission of Nursing Home Residents and Community‐Dwelling Elderly Adults Discharged from the Geriatrics Service of an Urban Teaching Hospital: Patterns and Risk Factors

Bogaisky, Michael; Dezieck, Laurel

doi:10.1111/jgs.13317

Cited by 47 publications

(65 citation statements)

References 14 publications

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“…This result is consistent with findings from other studies reporting that older community-dwelling adults (48, 65), vascular (66) and colorectal (67) surgery patients, and liver transplant recipients (68) who were discharged to care facilities were at significantly higher risk for readmission than those discharged home. This finding likely reflects the lower functional status of such patients (69) and thus higher risk for readmission.…”

Section: Discussionsupporting

confidence: 92%

“…Time-to-event was calculated from the date of index discharge until the date of first readmission. In addition, another competing risk regression analysis was conducted to identify the predictors of 30-day readmission, which is broadly used by hospitals, insurers and payers, and regulatory agencies to measure hospital quality and as a benchmark for reimbursement (4, 48). …”

Section: Methodsmentioning

confidence: 99%

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Pattern and Predictors of Hospital Readmission During the First Year After Lung Transplantation

Alrawashdeh

Zomak²,

Dew

et al. 2017

American Journal of Transplantation

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Hospital readmission after lung transplantation negatively impacts quality of life and resource utilization. A secondary analysis of data collected prospectively was conducted to identify the pattern (incidence, count, cumulative duration), reasons and predictors of readmission for 201 lung transplant recipients (LTR) assessed at 2, 6, and 12 months post-discharge. The majority of LTRs (83.6%) were readmitted, and 64.2% had multiple readmissions. The median cumulative readmission duration was 19 days. The main reasons for readmission were: other than infection or rejection (55.5%), infection only (25.4%), rejection only (9.9%), and infection and rejection (0.7%). LTRs who required reintubation (odd ratio [OR]=1.92; p=.008) or discharged to care facilities (OR=2.78; p=.008) were at higher risk for readmission with a 95.7% cumulative incidence of readmission at 12 months. Thirty-day readmission (40.8%) was not significantly predicted by baseline characteristics. Predictors for higher readmission count were lower capacity to engage in self-care (incidence rate ratio [IRR]=0.99; p=.03) and discharge to care facilities (IRR=1.45; p=.01). Predictors for longer cumulative readmission duration were older age (arithmetic mean ratio [AMR]=1.02; p=.009), return to ICU (AMR=2.00; p=.01), and lower capacity to engage in self-care (AMR=0.99; p=.03). Identifying LTRs at risk may assist in optimizing pre-discharge care, discharge planning, and long-term follow-up.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Pattern and Predictors of Hospital Readmission During the First Year After Lung Transplantation

Alrawashdeh

Zomak²,

Dew

et al. 2017

American Journal of Transplantation

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“…Diabetes mellitus ( n = 11) , obesity ( n = 7) and COPD ( n = 9) were the most frequently reported risk factors in the included articles (Table ). Different categories of body mass index (BMI) (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…The studies were mainly conducted in surgical (n = 14) [34][35][36][37][38][39][40][41][42][43][44][45][46][47] and cardiac (n = 11) [48][49][50][51][52][53][54][55][56][57][58] specialties. Other specialties included geriatrics [59][60][61][62][63][64], pneumology [65][66][67], general internal medicine [68,69] and intensive care [70]. Most studies evaluated readmission, only two studies focused on the occurrence of ADEs after discharge [34,64] and one had the combined endpoint of readmission due to ADEs [62].…”

Section: Risk Factors For Adverse Health Outcomes After Discharge Fromentioning

confidence: 99%

“…Time to readmission was restricted mostly to 30 days after discharge (n = 15) [39,43,44,48,49,52,54,55,57,60,61,63,65,69,70] but some studies covered longer periods before readmissione.g. 90-day readmission (n = 2) [58,65], and readmission within 1 year (n = 5) [50, 51, 55, 62, 66], 2 years (n = 1) [53] or even 3 years (n = 1) [56], and one study considered readmission without time restrictions [67].…”

Section: Risk Factors For Adverse Health Outcomes After Discharge Fromentioning

confidence: 99%

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Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach

Morath

Mayer

Send

et al. 2017

Brit J Clinical Pharma

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The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug-related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug-related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta-blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug-related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.

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Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department

et al. 2021

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Key Points Question Are hospital-at-home interventions consisting of, at minimum, home visits from nurses or physicians associated with better patient outcomes for adult patients with a chronic disease who present to an emergency department? Findings This systematic review of 9 randomized clinical trial studies, including 959 adult patients with a chronic disease, found that although patients receiving hospital-at-home care had an average length of treatment of 5.4 days longer than that of in-hospital patients and a similar mortality risk, they had a lower risk for readmission by 26% and a lower risk for long-term care admission relative to the in-hospital group. Patients who received hospital-at-home care also had lower depression and anxiety scores than patients receiving in-hospital care, but there was no difference in functional status. Meaning This systematic review provides further evidence that hospital-at-home interventions with at least 1 home visit from a nurse or physician may be a promising substitute to in-hospital care, especially for patients with chronic diseases who present to the emergency department.

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Early Hospital Readmission of Nursing Home Residents and Community‐Dwelling Elderly Adults Discharged from the Geriatrics Service of an Urban Teaching Hospital: Patterns and Risk Factors

Abstract: Higher rates of hospital readmission for individuals discharged to nursing homes than to the community and differing patterns of risk factors for readmission indicate the importance of customized interventions to reduce readmission rates for two distinct elderly populations.

Cited by 47 publications

References 14 publications

Pattern and Predictors of Hospital Readmission During the First Year After Lung Transplantation

Pattern and Predictors of Hospital Readmission During the First Year After Lung Transplantation

Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach

Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department

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