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Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis.

ABSTRACT: In the 30 days after hospital discharge, hospital utilisation is common and costly. This study evaluated the association between gender and hospital utilisation within 30 days of discharge.Secondary data analysis using Poisson regression stratified by gender.737 English-speaking hospitalised adults from general medical service in urban, academic safety-net medical centre who participated in the Project Re-Engineered clinical trial (clinicaltrials.gov identifier: NCT00252057).The primary end point was hospital utilisation, defined as total emergency department visits and hospital readmissions within 30 days after index discharge.Female subjects had a rate of 29 events for every 100 people and male subjects had a rate of 47 events for every 100 people (incident rate ratio (IRR) 1.62, 95% CI 1.28 to 2.06). Among men, risk factors included hospital utilisation in the 6 months prior to the index hospitalisation (IRR 3.55, 95% CI 2.38 to 5.29), being unmarried (IRR 1.72, 95% CI 1.12 to 2.64), having a positive depression screen (IRR 1.53, 95% CI 1.09 to 2.13) and no primary care physician (PCP) visit within 30 days (IRR 1.64, 95% CI 1.08 to 2.50). Among women, the only risk factor was hospital utilisation in the 6 months prior to the index hospitalisation (IRR 3.08, 95% CI 1.86 to 5.10).In our data, male subjects had a higher rate of hospital utilisation within 30 days of discharge than female subjects. For men-but not for women-risk factors were being retired, unmarried, having depressive symptoms and having no PCP visit within 30 days. Interventions addressing these factors might lower hospital utilisation rates observed among men.

SUBMITTER: Woz S

PROVIDER: S-EPMC3332240 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis.

Woz Shaula S Mitchell Suzanne S Hesko Caroline C Paasche-Orlow Michael M Greenwald Jeffrey J Chetty V K VK O'Donnell Julie J Jack Brian B

BMJ open 20120418 2

<h4>Objective</h4>In the 30 days after hospital discharge, hospital utilisation is common and costly. This study evaluated the association between gender and hospital utilisation within 30 days of discharge.<h4>Design</h4>Secondary data analysis using Poisson regression stratified by gender.<h4>Participants</h4>737 English-speaking hospitalised adults from general medical service in urban, academic safety-net medical centre who participated in the Project Re-Engineered clinical trial (clinicaltr ...[more]

PMID: 22514241

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Project description:Background: Hospital readmission rates are increasingly used as a measure of healthcare quality. Medicines are the most common therapeutic intervention but estimating the contribution of adverse drug events as a cause of readmissions is difficult. Objectives: To assess the prevalence and preventability of medication-related readmissions within 30 days after hospital discharge and to describe the risk factors, type of medication errors and types of medication involved in these preventable readmissions. Design: A cross-sectional observational study. Setting: The study took place across the cardiology, gastroenterology, internal medicine, neurology, psychiatry, pulmonology and general surgery departments in the OLVG teaching hospital, Netherlands. Participants: Patients with an unplanned readmission within 30 days after discharge from an earlier hospitalization (index hospitalization: IH) were reviewed. Measurements: The prevalence and preventability of medication-related readmissions were assessed by residents in multidisciplinary meetings. A senior internist and hospital pharmacist reassessed the prevalence and preventability of identified cases. Generalized estimating equation with logistic regression was performed to identify risk factors of potentially preventable medication-related readmissions. Results: Of 1,111 included readmissions, 181 (16%) were medication-related, of which 72 (40%) were potentially preventable. The number of medication changes at IH (Adjusted odds ratio [ORadj]: 1.14; 95% CI: 1.05-1.24) and having ≥3 hospitalizations 6 months before IH (ORadj: 2.11; 95% CI: 1.12-3.98) were risk factors of a preventable medication-related readmission. Of these preventable readmissions, 35% were due to prescribing errors, 35% by non-adherence and 30% by transition errors. Medications most frequently involved were diuretics and antidiabetics. Conclusion: This study shows that 16% of readmissions are medication-related, of which 40% are potentially preventable. If the results are confirmed in larger multicentre studies, this may indicate that more attention should be paid to medication-related harm in order to lower the overall readmission rates.

Project description:BackgroundPrevious studies have shown that approximately 20% of hospital readmissions can be medication-related and 70% of these readmissions are possibly preventable. This retrospective medical records study aimed to find risk factors associated with medication-related readmissions to hospital within 30 days of discharge in older adults (≥65 years).Methods30-day readmissions (n = 360) were assessed as being either possibly or unlikely medication-related after which selected variables were used to individually compare the two groups to a comparison group (n = 360). The aim was to find individual risk factors of possibly medication-related readmissions focusing on living arrangements, polypharmacy, potentially inappropriate medication therapy, and changes made to medication regimens at initial discharge.ResultsA total of 143 of the 360 readmissions (40%) were assessed as being possibly medication-related. Charlson Comorbidity Index (OR 1.15, 95%CI 1.5-1.25), excessive polypharmacy (OR 1.74, 95%CI 1.07-2.81), having adjustments made to medication dosages at initial discharge (OR 1.63, 95%CI 1.03-2.58) and living in your own home, alone, were variables identified as risk factors of such readmissions. Living in your own home, alone, increased the odds of a possibly medication-related readmission 1.69 times compared to living in your own home with someone (p-value 0.025) and 2.22 times compared to living in a nursing home (p-value 0.037).ConclusionPossibly medication-related readmissions within 30 days of discharge, in patients 65 years and older, are common. The odds of such readmissions increase in comorbid, highly medicated patients living in their own home, alone, and if having medication dosages adjusted at initial discharge. These results indicate that care planning before discharge and the provision of help with, for example, managing medications after discharge, are factors especially important if aiming to reduce the amount of medication-related readmissions among this population. Further research is needed to confirm this hypothesis.

Project description:Several care transition interventions propose that post-discharge phone calls can reduce adverse events and decrease costly return visits to the hospital. However, given the multi-faceted nature of most care transitions interventions, the true relationship between post-discharge phone calls and readmissions in a real world setting is uncertain.To determine the effect of receiving a post-discharge telephone call on all-cause 30-day readmission in a general medicine population.Retrospective observational study.Patients discharged home from the Medicine Service at a tertiary care academic medical center between November 2010 and May 2012.Patients received two telephone call attempts by a nurse within 72 h of discharge. Nurses followed a standard script to address issues associated with readmission.Billing data captured readmissions. We used logistic regression-adjusted patient and clinical covariates as well as a propensity score representing likelihood of being called to determine the association between call receipt and risk for readmission.There were 5,507 eligible patients. In unadjusted analyses, patients who received a call and completed the intervention were significantly less likely to be readmitted compared to those who did not [155 (5.8 %) vs 123 (8.6 %), p?<?0.01]. In multivariable models adjusting for socio-demographic and clinical covariates alone, completing a post-discharge telephone call intervention was associated with lower odds for readmission (AOR 0.71; 95 % CI: 0.55-0.91). However, when models adjusted for the likelihood of receiving the phone call using the propensity score, no association between call receipt and readmission was observed (AOR 0.91; 95%CI: 0.69-1.20).Effectiveness of post-discharge phone call programs may be more related to whether patients are able to answer a phone call than to the care delivered by the phone call. Programs would benefit from improving their ability to perform phone outreach while simultaneously improving on the care delivered during the calls.

Project description:OBJECTIVE:To determine any changes in total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the Hospital Readmissions Reduction Program (HRRP). DESIGN:Retrospective cohort study. SETTING:Hospital stays among Medicare patients for heart failure, acute myocardial infarction, or pneumonia between 1 January 2012 and 1 October 2015. PARTICIPANTS:Medicare fee-for-service patients aged 65 or over. MAIN OUTCOMES:Total hospital revisits within 30 days of discharge after hospital stays for medical conditions targeted by the HRRP, and by type of revisit: treat-and-discharge visit to an emergency department, observation stay (not leading to inpatient readmission), and inpatient readmission. Patient subgroups (age, sex, race) were also evaluated for each type of revisit. RESULTS:Our study cohort included 3 038 740 total index hospital stays from January 2012 to September 2015: 1 357 620 for heart failure, 634 795 for acute myocardial infarction, and 1 046 325 for pneumonia. Counting all revisits after discharge, the total number of hospital revisits per 100 patient discharges for target conditions increased across the study period (monthly increase 0.023 visits per 100 patient discharges (95% confidence interval 0.010 to 0.035)). This change was due to monthly increases in treat-and-discharge visits to an emergency department (0.023 (0.015 to 0.032) and observation stays (0.022 (0.020 to 0.025)), which were only partly offset by declines in readmissions (-0.023 (-0.035 to -0.012)). Increases in observation stay use were more pronounced among non-white patients than white patients. No significant change was seen in mortality within 30 days of discharge for target conditions (-0.0034 (-0.012 to 0.0054)). CONCLUSIONS:In the United States, total hospital revisits within 30 days of discharge for conditions targeted by the HRRP increased across the study period. This increase was due to a rise in post-discharge emergency department visits and observation stays, which exceeded the decline in readmissions. Although reductions in readmissions have been attributed to improvements in discharge planning and care transitions, our findings suggest that these declines could instead be because hospitals and clinicians have intensified efforts to treat patients who return to a hospital within 30 days of discharge in emergency departments and as observation stays.

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Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis.

Publications

Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis.

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