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

Content Provider	Semantic Scholar
Author	Wang, Hao Johnson, Carol Robinson, Richard D. Leuck, JoAnna Umejiego, Johnbosco Trop, Allison
Copyright Year	2016
Abstract	BACKGROUND Risks 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. METHODS Hospital 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. RESULTS A 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. CONCLUSIONS SOI 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.
Starting Page	294
Ending Page	300
Page Count	7
File Format	PDF HTM / HTML
Alternate Webpage(s)	https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-016-1814-7
PubMed reference number	27724889
Volume Number	16
Journal	BMC health services research
Language	English
Access Restriction	Open
Subject Keyword	Accident and Emergency department Demography Erectile dysfunction Hospital Readmissions Hospital admission Illness (finding) International Normalized Ratio Mental disorders Numerous Patient Visit Patients Substance abuse problem Substance-Related Disorders Urgent Care Centers
Content Type	Text
Resource Type	Article