JHM: Demographics, chronic conditions lead to more readmissions

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While race and payor status may make patients more susceptible for a first hospital readmission, having a chronic condition such as heart failure or diabetes and an increased body mass index (BMI) may also lead to additional hospital readmissions, according to two studies published online Oct. 12 in the Journal of Hospital Medicine.

In the first study, Nazima Allaudeen, MD, of the University of California, San Francisco (UCSF), and colleagues studied sociodemographic, clinical and operational factors that increased the risk of hospital readmission within 30 days of discharge. To do so the researchers evaluated a cohort of 10,359 consecutive hospital admissions of 6,805 general medicine patients at one tertiary care academic medical center between June 1, 2006 and May 31, 2008.

Allaudeen and colleagues found that the 30-day readmission rate was 17 percent. Additionally, they reported that black race, inpatient use of narcotics, corticosteroids and disease states of cancer, renal failure and congestive heart failure and weight loss affected readmission rates.

Patients who were Medicare beneficiaries also saw higher rates of readmission. “Within Medicare recipients, an astounding one in five medical patients (19.6 percent) is readmitted within 30 days, accounting for $15 billion in spending,” the authors wrote.

Currently, Medicare withholds payments to hospitals for hospital readmissions that take place within 24 hours of discharge; however, soon, Medicare may reduce payments to hospitals that have high rates of readmission within 30 days.

The authors noted that this is a “powerful incentive for hospitals to intervene,” and evaluate the risk factors that may be closely linked to readmissions.

“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,” concluded Allaudeen and colleagues.

In the second study, Alison M. Mudge, MB, of the Royal Brisbane and Women’s Hospital in Australia, and colleagues evaluated 142 inpatients aged 50 and over with previous hospitalizations within the last six months to identify certain factors that may be associated with the increased risk of recurrent readmissions.

Mudge et al found that 38.7 percent of the patients had an additional unplanned hospital readmission within six months. Heart failure, chronic renal impairment and diabetes were associated with the highest number of unplanned readmissions. Of the 21 percent of patients with heart failure, 57 percent were readmitted within six months.

Additionally, 15 percent of patients had chronic renal impairment and 25 percent had diabetes and 59 percent and 53 percent of patients with these conditions were readmitted to the hospital.

The researchers also found that patients who were considered obese or overweight had almost a two-fold higher risk of being readmitted to the hospital compared to those who were considered normal weight. Mudge et al found that depressive symptoms were linked to a higher rate of a hospital readmission.

“The population sampled had a high prevalence of chronic disease, and often multiple diseases,” the authors wrote. “Nutritional status and depressive symptoms are emerging as important modifiers of disease course and mortality in the setting of several chronic diseases; this study also supports their potential contribution to increased hospital resource consumption in a high-risk group.

“Post-hospital programs which specifically address these factors in the context of optimal medical management of underlying chronic diseases have the potential to reduce hospital readmissions,” Mudge and colleagues concluded.