30-Day Potentially Preventable Hospital Readmissions In Older Patients: Clinical Phenotype And Health Care Related Risk Factors

Abstract

Purpose

Early readmission rate has been regarded as an indicator of in-hospital and post-discharge quality of care. Evaluating the contributing factors is crucial to optimize the healthcare and target the intervention. In this study we evaluated the potential for preventing 30-day hospital readmission in a cohort of older patients and identified possible risk factors for readmission.

Patients and methods

Diagnosis-Related Group (DRG) codes of patients consecutively hospitalized for acute disease in the Geriatrics Unit of the University Hospital of Pisa within a 1-year window were recorded. All the patients had received a comprehensive geriatric assessment. Crossing and elaboration of the DRG codes was performed by the Potentially Preventable Readmission Grouping software (3M^™ Corporation). DRG codes were classified as stand-alone admissions (SA), index admissions (IA) and potentially preventable readmissions (PPR) within a time window of 30 days after discharge.

Results

In total, 1263 SA and 171 IA were identified, with an overall PPR rate of 11.9%. Hospitalizations were significantly longer in IA and PPR than SA (p<0.05). The more frequent readmission causes were acute heart failure, pulmonary edema, sepsis, pneumonia and stroke. In acute heart failure a nonlinear U-shaped readmission trend (with nadir at 5 days of hospitalization) was observed while, in all the other DRG codes, the PPR rate increased with increasing length of hospitalization. Comprehensive geriatric assessment showed a significantly lower degree of disability and comorbidity in SA than IA patients. At stepwise regression analysis, a high degree of disability and comorbidity as well as the diagnosis of sepsis emerged as independent risk factors for PPR.

Conclusion

Addressing PPR is crucial, especially in older patients. The adequacy of treatment during hospitalization (especially in cases of sepsis) as well as the setting of a comprehensive discharge plan, accounting for comorbidity and disability of the patients, are essential to reduce PPR.

Keywords:

• potentially preventable readmission
• length of stay
• multidimensional geriatric assessment
• older patients
• frailty

Acknowledgments

We wish to thank Drs Di Maio Alessandra, Vio Gabriele and Filippi Matteo, who helped in using the 3M^™ software and Dr Paola De Feo, for her assistance in collecting the data.

Abbreviations

DRG, Diagnosis-Related Group; SA, Stand-alone Admissions; IA, Index Admissions; PPR, potentially preventable readmissions; APR-DRG, All-Patient-Refined-Diagnosis-Related Group, CIRS, Cumulative Illness Rating Scale; ADL, Activities of Daily Living; IADL, Instrumental Activities of Daily Living; SPMSQ, Short Portable Mental Status Questionnaire; MNA, Mini Nutritional Assessment; CAM, Confusion Assessment Method; ED, emergency department; HF, heart failure.

Author Contributions

All authors contributed toward data analysis, drafting and revising the paper, gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.