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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Hao Wang, Carol Johnson, Richard D. Robinson, Vicki A. Nejtek, Chet D. Schrader, JoAnna Leuck, Johnbosco Umejiego, Allison Trop, Kathleen A. Delaney, Nestor R. Zenarosa

Published in: BMC Health Services Research | Issue 1/2016

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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.
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Literature
1.
Balla U, Malnick S, Schattner A. Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems. Medicine (Baltimore). 2008;87:294–300.CrossRef
2.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–28.CrossRefPubMed
3.
4.
Wallmann R, Llorca J, Gomez-Acebo I, et al. Prediction of 30-day cardiac-related-emergency-readmissions using simple administrative hospital data. Int J Cardiol. 2013;164:193–200.CrossRefPubMed
5.
Oduyebo I, Lehmann CU, Pollack CE, et al. Association of self-reported hospital discharge handoffs with 30-day readmissions. JAMA Intern Med. 2013;173:624–29.CrossRefPubMedPubMedCentral
6.
Singh M, Guth JC, Liotta E, et al. Predictors of 30-day readmission after subarachnoid hemorrhage. Neurocrit Care. 2013;19:306–10.CrossRefPubMed
7.
Chen HF, Popoola T, Radhakrishnan K, et al. Improving diabetic patient transition to home healthcare: leading risk factors for 30-day readmission. Am J Manag Care. 2015;21:440–50.PubMed
8.
Sharif R, Parekh TM, Pierson KS, et al. Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2014;11:685–94.CrossRefPubMedPubMedCentral
9.
Gili-Miner M, Bejar-Prado L, Gili-Ortiz E, et al. Alcohol use disorders among surgical patients: unplanned 30-days readmissions, length of hospital stay, excessive costs and mortality. Drug Alcohol Depend. 2014;137:55–61.CrossRefPubMed
10.
Coller RJ, Klitzner TS, Lerner CF, et al. Predictors of 30-day readmission and association with primary care follow-up plans. J Pediatr. 2013;163:1027–33.CrossRefPubMed
11.
Hunter T, Yoon RS, Hutzler L, et al. No evidence for race and socioeconomic status as independent predictors of 30-day readmission rates following orthopedic surgery. Am J Med Qual. 2015;30:484–88.CrossRefPubMed
12.
Morse RB, Hall M, Fieldston ES, et al. Children’s hospitals with shorter lengths of stay do not have higher readmission rates. J Pediatr. 2013;163:1034–38.CrossRefPubMed
13.
Feudtner C, Levin JE, Srivastava R, et al. How well can hospital readmission be predicted in a cohort of hospitalized children? A retrospective, multicenter study. Pediatrics. 2009;123:286–93.CrossRefPubMedPubMedCentral
14.
15.
van Walraven C, Dhalla IA, Bell C, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182:551–57.CrossRefPubMedPubMedCentral
16.
Donze J, Aujesky D, Williams D, et al. Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Intern Med. 2013;173:632–38.CrossRefPubMed
17.
Cooksley T, Nanayakkara PW, Nickel CH, et al. Readmissions of medical patients: an external validation of two existing prediction scores. QJM. 2016; 109(4): 245-8.
18.
Wang H, Robinson RD, Johnson C, et al. Using the LACE index to predict hospital readmissions in congestive heart failure patients. BMC Cardiovasc Disord. 2014;14:97.CrossRefPubMedPubMedCentral
19.
20.
Shen Y. All Patient Refined Diagnosis Related Groups Grouper to measure inpatient severity in the VA. Med Care. 2003;41:II103–10.PubMed
21.
Roberts MH, Mapel DW, Von WA, et al. Clinical factors, including All Patient Refined Diagnosis Related Group severity, as predictors of early rehospitalization after COPD exacerbation. Drugs Context. 2015;4. eCollection 2015. doi:10.​7573/​dic.​212278.
22.
Shulan M, Gao K, Moore CD. Predicting 30-day all-cause hospital readmissions. Health Care Manag Sci. 2013;16:167–75.CrossRefPubMed
23.
Lin CY, Barnato AE, Degenholtz HB. Physician follow-up visits after acute care hospitalization for elderly Medicare beneficiaries discharged to noninstitutional settings. J Am Geriatr Soc. 2011;59:1947–54.CrossRefPubMed
24.
Park HK, Branch LG, Bulat T, et al. Influence of a transitional care clinic on subsequent 30-day hospitalizations and emergency department visits in individuals discharged from a skilled nursing facility. J Am Geriatr Soc. 2013;61:137–42.CrossRefPubMed
25.
Tuso P, Huynh DN, Garofalo L, et al. The readmission reduction program of Kaiser Permanente Southern California-knowledge transfer and performance improvement. Perm J. 2013;17:58–63.CrossRefPubMedPubMedCentral
26.
Ota KS, Beutler DS, Gerkin RD, et al. Physician-directed heart failure transitional care program: a retrospective case review. J Clin Med Res. 2013;5:335–42.PubMedPubMedCentral
27.
Yu DS, Lee DT, Stewart S, et al. Effect of nurse-implemented transitional care for chinese individuals with chronic heart failure in Hong Kong: a randomized controlled trial. J Am Geriatr Soc. 2015;63:1583–93.CrossRefPubMed
28.
Fidahussein SS, Croghan IT, Cha SS, et al. Posthospital follow-up visits and 30-day readmission rates in chronic obstructive pulmonary disease. Risk Manag Healthc Policy. 2014;7:105–12.PubMedPubMedCentral
29.
Thygesen LC, Fokdal S, Gjorup T, et al. Can municipality-based post-discharge follow-up visits including a general practitioner reduce early readmission among the fragile elderly (65+ years old)? A randomized controlled trial. Scand J Prim Health Care. 2015;33:65–73.CrossRefPubMedPubMedCentral
30.
Christy S, Sin B, Gim S. Impact of an integrated pharmacy transitions of care pilot program in an urban hospital. J Pharm Pract. 2016;29:490–4.CrossRefPubMed
31.
Tang N, Fujimoto J, Karliner L. Evaluation of a primary care-based post-discharge phone call program: keeping the primary care practice at the center of post-hospitalization care transition. J Gen Intern Med. 2014;29:1513–18.CrossRefPubMedPubMedCentral
32.
Belsley DA, Kuh E, Welsch RE. Regression Diagnostics: Identifying Influential Data and Sources of Collinearity. New York: Wiley; 1980.CrossRef
33.
Ashton CM, Kuykendall DH, Johnson ML, et al. The association between the quality of inpatient care and early readmission. Ann Intern Med. 1995;122:415–21.CrossRefPubMed
34.
Amarasingham R, Velasco F, Xie B, et al. Electronic medical record-based multicondition models to predict the risk of 30 day readmission or death among adult medicine patients: validation and comparison to existing models. BMC Med Inform Decis Mak. 2015;15:39.CrossRefPubMedPubMedCentral
35.
Rice YB, Barnes CA, Rastogi R, et al. Tackling 30-day, all-cause readmissions with a patient-centered transitional care bundle. Popul Health Manag. 2016;19:56–62.CrossRefPubMed
36.
Arnold ME, Buys L, Fullas F. Impact of pharmacist intervention in conjunction with outpatient physician follow-up visits after hospital discharge on readmission rate. Am J Health Syst Pharm. 2015;72:S36–42.CrossRefPubMed
37.
Cavanaugh JJ, Lindsey KN, Shilliday BB, et al. Pharmacist-coordinated multidisciplinary hospital follow-up visits improve patient outcomes. J Manag Care Spec Pharm. 2015;21:256–60.CrossRefPubMed
38.
Buck DS, Brown CA, Mortensen K, et al. Comparing homeless and domiciled patients’ utilization of the Harris County, Texas public hospital system. J Health Care Poor Underserved. 2012;23:1660–70.CrossRefPubMed
39.
Lasser KE, Hanchate AD, McCormick D, et al. The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics. BMJ. 2014;348:g2329.CrossRefPubMedPubMedCentral
40.
Barrett TW, Self WH, Jenkins CA, et al. Predictors of regional variations in hospitalizations following emergency department visits for atrial fibrillation. Am J Cardiol. 2013;112:1410–16.CrossRefPubMedPubMedCentral
41.
Doran KM, Ragins KT, Iacomacci AL, et al. The revolving hospital door: hospital readmissions among patients who are homeless. Med Care. 2013;51:767–73.CrossRefPubMed
42.
Burke D, Link N, Bails D, et al. A taxonomy of seven-day readmissions to an urban teaching hospital. J Hosp Med. 2016;11:33-8.
Metadata
Title
Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions
Authors
Hao Wang
Carol Johnson
Richard D. Robinson
Vicki A. Nejtek
Chet D. Schrader
JoAnna Leuck
Johnbosco Umejiego
Allison Trop
Kathleen A. Delaney
Nestor R. Zenarosa
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1814-7

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