Redefining readmission risk factors for general medicine patients

Abstract

BACKGROUND:Readmissions are costly both financially for our healthcare system and emotionally for our patients. Identifying factors that increase risk for readmissions may be helpful to focus resources to optimize the discharge process and reduce avoidable readmissions.OBJECTIVE:To identify factors associated with readmission within 30 days for general medicine patients.METHODS:We performed a retrospective observational study of an administrative database at an urban 550‐bed tertiary care academic medical center. Cohort patients were discharged from the general medicine service over a 2‐year period from June 1, 2006, to May 31, 2008. Clinical, operational, and sociodemographic factors were evaluated for association with readmission.RESULTS:Our cohort included 10,359 consecutive admissions (6805 patients) discharged from the general medicine service. The 30‐day readmission rate was 17.0%. In multivariate analysis, factors associated with readmission included black race (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.24–1.65), inpatient use of narcotics (1.33; 1.16–1.53) and corticosteroids (1.24; 1.09–1.42), and the disease states of cancer (with metastasis 1.61; 1.33–1.95; without metastasis 1.95; 1.54–2.47), renal failure (1.19; 1.05–1.36), congestive heart failure (1.30; 1.09–1.56), and weight loss (1.26; 1.09–1.47). Medicaid payer status (1.15; 0.97–1.36) had a trend toward readmission.CONCLUSION:Readmission of general medicine patients within 30 days is common and associated with several easily identifiable clinical and nonclinical factors. Identification of these risk factors can allow providers to target interventions to reduce potentially avoidable readmissions. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

“…Allaudeen et al showed in multivariable analysis of more than 10,000 consecutive general medicine patients in a tertiary care academic medical center that cancer with or without metastasis was a factor associated with readmission. 5 A retrospective single-institution cohort study by Schairer et al similarly found a higher rate of readmission for patients with primary and metastatic tumors of the spine. In their study, they reported a readmission rate of 14.2% and also confirmed that infectious complications were the most common cause for readmission.…”

Hospital readmission rates in Medicare

“…Almost 20% of Medicare beneficiaries are readmitted within 30 days of discharge costing about $15 billion annually [7][8][9] , of which about $12 billion is potentially avoidable [10] . Certain patient characteristics, such as demographic factors, medical history, and diseases and comorbidities, have been found to increase the likelihood of a readmission [7,11] .…”

“…Another study found that heart attack, pneumonia, and congestive heart failure are three key diagnoses that require special attention due to higher than average readmission rates [17] . Allaudeen and colleagues found that having comorbidities (congestive heart failure, renal disease, cancer) is positively associated with readmissions [8] . Rau identified heart failure as the most common condition affecting readmissions, with hospitals serving the poorest Medicare patients being nearly three times as likely as others to have substantially high readmission rates for this condition [10] .…”

Perceptions of readmitted patients on the transition from hospital to home

“…Patients with low socioeconomic status (SES) are up to 43% more likely to require readmission than their higher-SES counterparts, 8,9 and qualitative data has described unique challenges faced by low-SES patients during transition. 2 Our objectives were to understand the transition experiences of readmitted patients and to compare these experiences across SES and diagnostic categories.…”