Preventing hospital readmissions: the importance of considering ‘impactibility,’ not just predicted risk

Steventon, Adam; Billings, John

doi:10.1136/bmjqs-2017-006629

Cited by 32 publications

(42 citation statements)

References 32 publications

(28 reference statements)

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“…Therefore there may be patient and system factors that are not reflected in these data sources. The disparate results of low Charlson Comorbidity Scores and moderate degree of health service use in the 6 months preceding readmission, and reports that patient characteristics not captured in organisational or medical record data such as behaviours, that may influence readmission [ 32 ] add weight to this assertion. Further, organisational and medical record data do not provide detailed information about health care provider characteristics and there is emerging evidence of hospital factors that contribute to readmissions independent of patient factors.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study

Considine

Berry

Newnham

et al. 2018

BMC Health Serv Res

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BackgroundUnplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable.MethodsA retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015.ResultsIn Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1–5 hospital admissions in the 6 months preceding index admission.In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission.ConclusionsAdvanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning.

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Section: Discussionmentioning

confidence: 99%

Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study

Considine

Berry

Newnham

et al. 2018

BMC Health Serv Res

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“…15 Despite this accuracy, these risk identification tools do not identify modifiable risk factors for hospital readmission. 10,16,17 Identifying and evaluating potentially modifiable risk factors for readmission, such as polypharmacy, is a focus of active investigation. 2,18,19 The role of polypharmacy as an independent risk factor predicting 30-day readmission is a recent debate.…”

Section: Introductionmentioning

confidence: 99%

Predictors of 30-day hospital readmission: The direct comparison of number of discharge medications to the HOSPITAL score and LACE index

Robinson

Bhattarai

Hudali

et al. 2019

Future Healthcare Journal

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Effective hospital readmission risk prediction tools exist, but do not identify actionable items that could be modifi ed to reduce the risk of readmission. Polypharmacy has attracted attention as a potentially modifi able risk factor for readmission, showing promise in a retrospective study. Polypharmacy is a very complex issue, refl ecting comorbidities and healthcare resource utilisation patterns. This investigation compares the predictive ability of polypharmacy alone to the validated HOSPITAL score and LACE index readmission risk assessment tools for all adult admissions to an academic hospitalist service at a moderate sized university-affi liated hospital in the American Midwest over a 2-year period. These results indicate that the number of discharge medications alone is not a useful tool in identifying patients at high risk of hospital readmission within 30 days of discharge. Further research is needed to explore the impact of polypharmacy as a risk predictor for hospital readmission.

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“…In 2016 one in three older people in the UK were living alone, an increase of 16% over two decades [ 1 – 3 ]. To address the complex health needs of older people who are often living with multiple-long term conditions [ 4 ], commissioners and clinicians often attempt to identify those at highest risk of hospital admission to target with additional clinical community care and enhanced social support [ 5 – 7 ]. However, there has been limited success in the application of such care models, perhaps because the majority of risk stratification tools use only selected clinical data and do not consider patient preferences or the wider social support a patient may have access to in their home, family or the community [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

The association between living alone and health care utilisation in older adults: a retrospective cohort study of electronic health records from a London general practice

et al. 2018

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BackgroundIn 2016, one in three older people in the UK were living alone. These patients often have complex health needs and require additional clinical and non-clinical support. This study aimed to analyse the association between living alone and health care utilisation in older patients.MethodsWe conducted a retrospective cohort study of 1447 patients over the age of 64, living in 1275 households who were registered at a large general practice in South East London. The utilisation of four different types of health care provision were examined in order to explore the impact of older patients living alone on health care utilisation.ResultsAfter adjusting for patient demographics and clinical characteristics, living alone was significantly associated with a higher probability of utilising emergency department and general practitioner services, with odds ratios of 1.50 (95% confidence interval [CI] 1.16 to 1.93) and 1.40 (95% CI 1.04 to 1.88) respectively.ConclusionsLiving alone has an impact on health care service utilisation for older patients. We show that general practice data can be used to identify older patients who are living alone, and general practitioners are in a unique position to identify those who could benefit from additional clinical and non-clinical support. Further research is needed to understand the mechanism driving higher utilisation for those patients who live alone.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0939-4) contains supplementary material, which is available to authorized users.

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Preventing hospital readmissions: the importance of considering ‘impactibility,’ not just predicted risk

Cited by 32 publications

References 32 publications

Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study

Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study

Predictors of 30-day hospital readmission: The direct comparison of number of discharge medications to the HOSPITAL score and LACE index

The association between living alone and health care utilisation in older adults: a retrospective cohort study of electronic health records from a London general practice

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