As payers, providers and policymakers look for ways to address hospital readmissions, research published Wednesday in the Journal of Hospital Medicine offer insight into possible risk factors.
The authors of "Redefining Readmission Risk Factors for General Medicine Patients" find that being African American and receiving Medicaid are both factors.
"Though current strategies focus largely on clinical risk factors, this study shows that nonclinical factors play an equally important but underappreciated role in contributing to readmission," the authors write. They conclude that identification of these factors can help providers target interventions to potentially reduce readmissions.
In a retrospective observational study of an administrative database, Nazima Allaudeen, MD, and colleagues at the University of California San Francisco, examined the factors behind unplanned hospital readmission within 30 days.
This study looked at 6,805 patients (10,359 admissions) admitted to UCSF hospitals between June 2006 and May 2008. Seventeen percent of admissions were readmitted within 30 days, with 49.7 percent occurring within 10 days.
Both being African-American and being on Medicaid were associated with readmission, (43 percent and 15 percent increased risks of readmission respectively) after adjustment for other variables.
Of the clinical factors, high-risk medications and several comorbidities (congestive heart failure, renal disease, cancer [with and without metastasis], weight loss, and iron-deficiency anemia) were associated with readmission. Researchers also examined operational factors (e.g., weekend discharge), but none was significantly associated with readmission.
"Given the breadth of risk factors we identified, it seems likely that more intensive interventions will require a multidisciplinary approach, one which might be costly if applied broadly. Our study does not attempt to predict who will be readmitted and who will not, but rather provides a list of risk factors which might be used to deploy resources more efficiently."
"The US spends over $15 billion in Medicare on readmissions to hospital within 30 days and readmissions are also distressing to patients and their caregivers," Allaudeen, now based at the VA Palo Alto Health Care System, California, said in a statement. "Many healthcare systems are now making efforts to improve the transition from hospital to home or nursing facility to try to reduce preventable readmissions but they need to know which patients to focus on to have the biggest impact. Studies like ours should give practitioners direction to non-clinical factors to identify."
She and her colleagues note that further, in-depth research is needed—research that incorporates the patient experience. "Both black race and Medicaid as payer are proxies for the underlying root cause aspects leading to readmission, such as access to longitudinal care. Following this trail to the ‘root cause’ will require in-depth qualitative evaluation that includes the patient perspective as a source of data," they write.
The authors place this task with the hospitalist. "Hospitalists, who are at nexus of the discharge process and uniquely invested in quality inpatient care, are ideally positioned to lead efforts to reduce readmissions."
See Also:
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