Risk factors for 30-day hospital readmission in patients ≥65 years of age - PubMed (original) (raw)

Risk factors for 30-day hospital readmission in patients ≥65 years of age

Marc D Silverstein et al. Proc (Bayl Univ Med Cent). 2008 Oct.

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.

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Figures

Figure 1

Figure 1

Prevalence of risk factors for 30-day hospital readmission. The prevalence of the significant demographic, health system, and Elixhauser comorbidity predictors of 30-day hospital readmission among the 29,292 eligible elders admitted to the seven BHCS hospitals from July 2002 to June 2004 is shown.

Figure 2

Figure 2

Relative risk of 30-day hospital readmission. The relative risk and 95% confidence intervals for the significant demographic, health system, and Elixhauser comorbidity predictors of 30-day hospital readmission among the 29,292 eligible elders admitted to the seven BHCS hospitals from July 2002 to June 2004 are shown.

Figure 3

Figure 3

Population-attributable risk (PAR) of 30-day hospital readmission. The population-attributable risk of the significant demographic, health system, and Elixhauser comorbidity predictors of 30-day hospital readmission among the 29,292 eligible elders admitted to the seven BHCS hospitals from July 2002 to June 2004 is shown. Among these elders, dual Medicare and Medicaid insurance, no Medicare insurance coverage, admission to a surgical service, or hypertension with complications as a comorbidity were associated with a significantly lower risk of 30-day hospital admission.

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