Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions

Abstract

BackgroundRisks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission.MethodsHospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated.ResultsA total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 % CI 1.25–1.38) and 1.09 (ROM: 95 % CI 1.05–1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed.ConclusionsSOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.

Malnutrition and depression as predictors for 30-day unplanned readmission in older patient: a prospective cohort study to develop 7-point scoring system

“…We believed that the subjects in our national referral hospital had more severe illnesses than the general older inpatients in Indonesia and thus required longer inpatient care. Most of our subjects also had severe comorbidities, which may be typical for older inpatients in a referral hospital [ 20 ] and can be related to higher readmission [ 21 ].…”

Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy

“…However, our model used an all-payer diagnostic code and comorbidity adjustment factors that considered the severity of a child’s presentation. 10 , 11 …”

“…Higher APR-DRG levels in the risk of mortality and disease severity categories are associated with higher readmission rates and other adverse outcomes. 10 , 11 …”

The association between hospital care transition planning and timely primary care follow‐up

“…Studies that specifically examine postdischarge outpatient follow‐up rates are sparse, focus on different populations, and use varying time frames for follow‐up, yielding mixed results. Studies conducted within clinical systems have noted follow‐up rates from 33% to 41% for 30‐day follow‐up in a general patient population 13 to 50% follow‐up within 7 days for Medicare Advantage individuals 8 . Research based on Medicare claims data has documented 72%‐75% 30‐day follow‐up visit rates among patients with selected high‐risk diagnoses 14 .…”