Risk factors and costs associated with 30-day readmissions following alcohol-related hospitalizations in the United States from 2010 to 2015

Silverstein, Alison R.; Kee, Rebecca; Gleeson, Carole D.; Sussell, Jesse; O’Sullivan, Amy K.; Goldman, Dana P.; Hasin, Deborah S.

doi:10.1016/j.alcohol.2020.08.003

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Our study builds on prior work characterizing clinical outcomes after alcohol-related hospitalizations. We found a higher 30-day readmission rate (34.3%) than a prior study that identified a 14% rate after alcohol-related hospitalizations in 2015 . These differences may be explained by our cohort characteristics, including older age and a high proportion of patients with disabilities.…”

Section: Discussioncontrasting

confidence: 76%

“…We found a higher 30-day readmission rate (34.3%) than a prior study that identified a 14% rate after alcohol-related hospitalizations in 2015. 33 These differences may be explained by our cohort characteristics, including older age and a high proportion of patients with disabilities. The high rate of return to hospital in the 30 days after alcohol-related hospitalizations and the finding that less than half of such patients attended a primary care or mental health follow-up appointment emphasizes an urgent need to implement interventions to promote more effective transitions of care to the outpatient setting.…”

Section: Discussionmentioning

confidence: 94%

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Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge

Bernstein,

Baggett,

Trivedi

et al. 2024

JAMA Netw Open

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ImportanceUS Food and Drug Administration–approved medications for alcohol use disorder (MAUD) are significantly underused. Hospitalizations may provide an unmet opportunity to initiate MAUD, but few studies have examined clinical outcomes of patients who initiate these medications at hospital discharge.ObjectiveTo investigate the association between discharge MAUD initiation and 30-day posthospitalization outcomes.Design, Setting, and ParticipantsThis cohort study was conducted among patients with Medicare Part D who had alcohol-related hospitalizations in 2016. Data were analyzed from October 2022 to December 2023.ExposuresDischarge MAUD initiation was defined as oral naltrexone, acamprosate, or disulfiram pharmacy fills within 2 days of discharge.Main outcomesThe primary outcome was a composite of all-cause mortality or return to hospital (emergency department visits and hospital readmissions) within 30 days of discharge. Secondary outcomes included these components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. Propensity score 3:1 matching and modified Poisson regressions were used to compare outcomes between patients who received and did not receive discharge MAUD.ResultsThere were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 [46-62] years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 192 hospitalizations (2.0%) involved discharge MAUD initiation. After propensity matching, discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58 [95% CI, 0.45 to 0.76]; absolute risk difference, −0.18 [95% CI, −0.26 to −0.11]). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56 [95% CI, 0.43 to 0.73]) except for mortality, which was rare in both groups (incident rate ratio, 3.00 [95% CI, 0.42 to 21.22]). Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital (incident rate ratio, 0.49 [95% CI, 0.34 to 0.71]; absolute risk difference, −0.15 [95% CI, −0.22 to −0.09]).Conclusion and relevanceIn this cohort study, discharge initiation of MAUD after alcohol-related hospitalization was associated with a large absolute reduction in return to hospital within 30 days. These findings support efforts to increase uptake of MAUD initiation at hospital discharge.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 94%

Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge

Bernstein,

Baggett,

Trivedi

et al. 2024

JAMA Netw Open

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“… 51 Between 2010 and 2015, 1.1 million hospitalizations had an alcohol-related primary diagnosis, representing nearly 1% of all adult index hospitalizations. 52 High-risk drinkers may disproportionately use acute care, as they had more emergency department visits and intensive care admissions, more days spent in acute care, and more 30-day readmissions than low-risk drinkers. 53 , 54 Furthermore, the burden of alcohol consumption on hospitals has increased over time.…”

Section: Resultsmentioning

confidence: 99%

“… 51 Between 2010 and 2015, the annual rate of 30-day readmissions for alcohol-related hospitalizations rose 17.6%, whereas 30-day readmissions overall decreased. 52 …”

Section: Resultsmentioning

confidence: 99%

Rethinking Unhealthy Alcohol Use in the United States: A Structured Review

Volpicelli¹,

Menzies

2022

Subst�Abuse

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Greater than moderate alcohol use spans a continuum that includes high levels of total alcohol consumed per period (heavy drinking) as well as episodes of intense drinking (binges) and can give rise to alcohol use disorder (AUD) when associated with an inability to control alcohol use despite negative consequences. Although moderate drinking and AUD have standard, operable definitions in the United States (US), a significant “gray area” remains in which an individual may exceed recommended drinking guidelines but does not meet the criteria for AUD (hereafter referred to as unhealthy alcohol use). To address this need, we conducted a structured literature search to evaluate how this gray area is defined and assess its burden within the US. For purposes of this review, we will refer to this gray area as “unhealthy alcohol use.” Although numerous terms are used to describe various unsafe drinking practices, our review did not find any studies in which the specific prevalence and/or burden of unhealthy alcohol use was evaluated. That is, we found no studies that focus exclusively on individuals who exceed moderate drinking guidelines but do not meet AUD criteria. Furthermore, we did not discover an established framework for identifying individuals with unhealthy alcohol use. The lack of a consistent framework for identifying unhealthy alcohol users has significant implications for patient management and disease burden assessment. Therefore, we propose the following framework in which unhealthy alcohol use comprises 2 distinct subpopulations: those at risk of experiencing alcohol-related consequences and those who have subthreshold problems associated with use. The former, termed “risky drinkers,” are defined by exceeding recommended guidelines for moderate drinking (⩽1 or 2 drinks per day for women and men, respectively). People with subthreshold problems associated with use, defined as exhibiting exactly 1 AUD symptom, would be classified as “problematic drinkers” within this proposed framework. These definitions would help bring the core elements of unhealthy alcohol use into focus, which in turn would help identify and provide management strategies sooner to those affected and reduce the overall burden of unhealthy alcohol use.

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“…For individuals with mood disorders, who account for double the number of hospital stays as those with schizophrenia, the cost of readmission was greater than the cost of their initial hospital stay ($5800 per stay vs. $7200, respectively). In 2014, the average hospitalisation for treatment of psychotic disorders cost approximately $8600, and the average readmission cost for treatment of alcohol use disorder was $11,196 (Silverstein et al, 2020; Wani et al, 2019). In 2018, schizophrenia, depressive disorders and alcohol‐related disorders all ranked among the 20 diagnoses with the highest 30‐day all‐cause readmission rates (Weiss & Jiang, 2021).…”

mentioning

confidence: 99%

Personality predictors of 6‐month readmission in adult psychiatric inpatients

et al. 2022

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Readmission of psychiatric inpatients is highly prevalent and places a significant financial burden on the healthcare system. Rehospitalisation is often used as a metric of quality of care in psychiatric settings, but little is known about how specific personality traits impact readmission in adult psychiatric inpatients. A convenience sample of 94 adults (mean age = 36.8 years; female = 54.3%; European American = 76.6%) at an inpatient psychiatric hospital completed the Personality Inventory for DSM‐5‐Brief Form (PID‐5‐BF; American Psychiatric Association, 2013); demographic and medical information and readmission data were extracted via chart review. Poisson regression was used to predict number of readmissions at 6 months after discharge from PID‐5‐BF domain scores of Negative Affectivity, Detachment, Antagonism, Disinhibition and Psychoticism. Twenty‐three patients (24.5%) were readmitted at least once by 6‐month follow‐up. Higher PID‐5‐BF Negative Affectivity domain scores predicted greater number of readmissions at 6 months (incidence rate ratio (IRR) = 1.14, robust standard error (RSE) = 0.05, p < .01, 95% confidence interval [1.04, 1.25]). The other PID‐5‐BF domain scores were not significantly related to number of readmissions. Thus, greater negative affect, indicative of higher trait neuroticism, heightened experience of negative emotions and poor self‐concept, was a significant personality predictor of readmission in the study. These results suggest that assessing this trait domain might help to identify psychiatric inpatients at greater risk for readmission and determine those most in need of enhanced services to reduce rehospitalisation.

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Risk factors and costs associated with 30-day readmissions following alcohol-related hospitalizations in the United States from 2010 to 2015

Cited by 5 publications

References 22 publications

Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge

Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge

Rethinking Unhealthy Alcohol Use in the United States: A Structured Review

Personality predictors of 6‐month readmission in adult psychiatric inpatients

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