Risk Factors for 30-Day Hospital Readmission in Patients ≥65 Years of Age

Abstract

The objective of the study was to develop and validate predictors of 30-day hospital readmission using readily available administrative data and to compare prediction models that use alternate comorbidity classifications. A retrospective cohort study was designed; the models were developed in a two-thirds random sample and validated in the remaining one-third sample. The study cohort consisted of 29,292 adults aged 65 or older who were admitted from July 2002 to June 2004 to any of seven acute care hospitals in the Dallas-Fort Worth metropolitan area affiliated with the Baylor Health Care System. Demographic variables (age, sex, race), health system variables (insurance, discharge location, medical vs surgical service), comorbidity (classified by the Elixhauser classification or the High-Risk Diagnoses in the Elderly Scale), and geographic variables (distance from patient's residence to hospital and median income) were assessed by estimating relative risk and risk difference for 30-day readmission. Population-attributable risk was calculated. Results showed that age 75 or older, male sex, African American race, medical vs surgical service, Medicare with no other insurance, discharge to a skilled nursing facility, and specific comorbidities predicted 30-day readmission. Models with demographic, health system, and either comorbidity classification covariates performed similarly, with modest discrimination (C statistic, 0.65) and acceptable calibration (Hosmer-Lemeshow χ² = 6.08; P > 0.24). Models with demographic variables, health system variables, and number of comorbid conditions also performed adequately. Discharge to long-term care (relative risk, 1.94; 95% confidence interval, 1.80- 2.09) had the highest population-attributable risk of 30-day readmission (12.86%). A 25% threshold of predicted probability of 30-day readmission identified 4.1 % of patients ≥65 years old as priority patients for improved discharge planning. We conclude that elders with a high risk of 30-day hospital readmission can be identified early in their hospital course.

Risk factors for hospital readmission of elderly patients

“…Also liver diseases were associated with readmission, in agreement with a previous study based upon 30-day readmission [7].…”

Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

“…Among the 304 readmissions, the median (IQR) time to readmission was 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) days. The most common readmission diagnoses by CCS Level 3 category were congestive heart failure, pneumonia, coronary atherosclerosis without acute myocardial infarction, cardiac dysrhythmias, and obstructive chronic bronchitis, which together accounted for 25 % of readmissions.…”

“…We also excluded institutionalized Medicare beneficiaries (6 % of MCBS participants) because factors influencing their readmissions and potential interventions likely differ from adults in the community. 6 Finally, we did not exclude "elective readmissions," which are estimated to be about 10 % of hospital readmissions; these patients are probably less likely to die than those who are urgently readmitted. Healthy volunteer bias and survivor effects further reduced our cohort's early readmission rate; our study could not include persons who were too sick to enroll in the MCBS at all, who died before the baseline interview in the second year or during the index hospitalization, or who were discharged with hospice care.…”

“…Hospital readmission could trigger discussions among the patient, family, and health care providers about current treatments, quality of life, need and provisions for home support, and overall goals of care in the setting of progressive or terminal disease. Research has connected some readmissions with potentially modifiable factors, 4,6,20 -such as lack of patient education on discharge, unmet functional needs, and poor access to care-to which physicians treating readmitted patients should devote particular attention. Several multidisciplinary discharge interventions to prevent hospital readmissions have been developed, [21][22][23] and our data support additional efforts oriented specifically toward the communitydwelling geriatric population.…”

“…Among all hospitalized Medicare beneficiaries (including community-dwelling and institutionalized elders, as well as younger disabled Medicare beneficiaries), nearly one in five were readmitted within 30 days, and over one-third were readmitted within 90 days. 1 These readmitted individuals have been described in some detail; research has identified early readmission risk factors for general 2,3 and geriatric populations, [4][5][6] as well as those with specific diseases such as heart failure, 7 stroke, 8 and chronic obstructive pulmonary disease. 9 Individuals readmitted early are more likely to have multiple medical comorbidities, greater length of stay during the index hospitalization, and additional recent hospitalizations.…”