Preventable Readmission Risk Factors for Patients With Chronic Conditions

Abstract

Evidence indicates that the largest volume of hospital readmissions occurs among patients with preexisting chronic conditions. Identifying these patients can improve the way hospital care is delivered and prioritize the allocation of interventions. In this retrospective study, we identify factors associated with readmission within 30 days based on claims and administrative data of nine hospitals from 2005 to 2012. We present a data inclusion and exclusion criteria to identify potentially preventable readmissions. Multivariate logistic regression models and a Cox proportional hazards extension are used to estimate the readmission risk for 4 chronic conditions (congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], acute myocardial infarction, and type 2 diabetes) and pneumonia, known to be related to high readmission rates. Accumulated number of admissions and discharge disposition were identified to be significant factors across most disease groups. Larger odds of readmission were associated with higher severity index for CHF and COPD patients. Different chronic conditions are associated with different patient and case severity factors, suggesting that further studies in readmission should consider studying conditions separately.

Development and Validation of a Novel Tool to Predict Hospital Readmission Risk Among Patients with Diabetes

“…First, the C statistic of 0.70 is comparable to the C statistic reported with other models developed for diabetes patients (8,10,26). Likewise, a systematic review identified 7 readmission risk prediction models not restricted to diabetes that could be used to identify high-risk patients during a hospitalization, with C statistics ranging from 0.56 to 0.72 (29).…”

“…Although discharge within 90 days prior to admission has not specifically been reported by other groups, prior hospitalizations and emergency department visits have been shown to predict 30-d readmission risk (7,10,26). Likewise, diabetes complications; preadmission insulin use; and admission serum hematocrit, sodium, and creatinine have not been previously identified as predictors of 30-d readmission, but several other groups have demonstrated that comorbidity burden is associated with readmission risk (7,8,10,26,27). In contrast, anemia has been previously reported (28).…”

“…A total of 46 sociodemographic and clinical characteristics were examined as potential predictors of 30-d readmission, expanding the existing body of literature (7,8,10,11,26,32) In addition, DERRI ™ performance was similar between the training and validation samples. Lastly, we are unaware of any previously published model specifically designed for use prior to discharge that predicts 30-d readmission risk for patients with diabetes.…”

Predicting readmission risk of patients with diabetes hospitalized for cardiovascular disease: a retrospective cohort study

“…Although discharge within 90 days prior to admission has not specifically been reported by other groups, prior hospitalizations and emergency department visits have been shown to predict 30d readmission risk [25, 22, 30]. Likewise, diabetes complications have not been previously isolated in published studies as predictors of 30d readmission, however several other groups have demonstrated that comorbidity burden is associated with readmission risk [23, 25, 22, 31, 30].…”

“…Likewise, diabetes complications have not been previously isolated in published studies as predictors of 30d readmission, however several other groups have demonstrated that comorbidity burden is associated with readmission risk [23, 25, 22, 31, 30]. In addition, educational attainment has not been previously associated with 30d readmission.…”