Readmissions in Patients With Common Comorbidities
Readmissions in Patients With Common Comorbidities
Objective To evaluate the primary diagnoses and patterns of 30 day readmissions and potentially avoidable readmissions in medical patients with each of the most common comorbidities.
Design Retrospective cohort study.
Setting Academic tertiary medical centre in Boston, 2009-10.
Participants 10,731 consecutive adult discharges from a medical department.
Main outcome measures Primary readmission diagnoses of readmissions within 30 days of discharge and potentially avoidable 30 day readmissions to the index hospital or two other hospitals in its network.
Results Among 10,731 discharges, 2,398 (22.3%) were followed by a 30 day readmission, of which 858 (8.0%) were identified as potentially avoidable. Overall, infection, neoplasm, heart failure, gastrointestinal disorder, and liver disorder were the most frequent primary diagnoses of potentially avoidable readmissions. Almost all of the top five diagnoses of potentially avoidable readmissions for each comorbidity were possible direct or indirect complications of that comorbidity. In patients with a comorbidity of heart failure, diabetes, ischemic heart disease, atrial fibrillation, or chronic kidney disease, the most common diagnosis of potentially avoidable readmission was acute heart failure. Patients with neoplasm, heart failure, and chronic kidney disease had a higher risk of potentially avoidable readmissions than did those without those comorbidities.
Conclusions The five most common primary diagnoses of potentially avoidable readmissions were usually possible complications of an underlying comorbidity. Post-discharge care should focus attention not just on the primary index admission diagnosis but also on the comorbidities patients have.
Preventable readmissions to hospital are frequent, costly, and demanding on healthcare resources; they also represent threats to patients' safety such as preventable adverse drug events, healthcare associated infections, procedural complications, and avoidable exacerbations in disease states or functional declines. The recent focus on readmissions in some countries, including the United States, Germany, Switzerland, and England, driven in part by their effects on costs, thus underlies a much more global concern about patients' safety.
Hospital readmission represents a multifaceted problem that still needs to be better understood. Evidence shows that readmission diagnoses usually differ from the specific acute diagnosis responsible for the index hospital admission. On the other hand, higher comorbidity has been shown to be associated with an increased risk of readmission. Also, in a recent study, most of the 30 day readmissions after pneumonia were found to be comorbidity related. Thus, the role of comorbidities in causing readmissions is complex, but relatively few studies have looked at this. The subject will take on greater importance as a growing percentage of the world's population becomes older and the incidence of comorbidities rises.
A better understanding of the causes and patterns of readmissions in patients with common comorbidities may lead to more targeted and successful interventions, and these strategies may differ by condition. In addition, few data are available regarding to what extent the causes and patterns of all cause readmissions differ from the readmissions that are avoidable and thus actionable. We hypothesized that patients' comorbidities have an important role in the primary diagnosis of 30 day potentially avoidable readmission and that preventability of readmissions may vary among patients with different comorbidities. Therefore, our aim was to evaluate the primary diagnoses and patterns of 30 day readmissions and potentially avoidable readmissions according to the most common comorbidities in medical patients.
Abstract and Introduction
Abstract
Objective To evaluate the primary diagnoses and patterns of 30 day readmissions and potentially avoidable readmissions in medical patients with each of the most common comorbidities.
Design Retrospective cohort study.
Setting Academic tertiary medical centre in Boston, 2009-10.
Participants 10,731 consecutive adult discharges from a medical department.
Main outcome measures Primary readmission diagnoses of readmissions within 30 days of discharge and potentially avoidable 30 day readmissions to the index hospital or two other hospitals in its network.
Results Among 10,731 discharges, 2,398 (22.3%) were followed by a 30 day readmission, of which 858 (8.0%) were identified as potentially avoidable. Overall, infection, neoplasm, heart failure, gastrointestinal disorder, and liver disorder were the most frequent primary diagnoses of potentially avoidable readmissions. Almost all of the top five diagnoses of potentially avoidable readmissions for each comorbidity were possible direct or indirect complications of that comorbidity. In patients with a comorbidity of heart failure, diabetes, ischemic heart disease, atrial fibrillation, or chronic kidney disease, the most common diagnosis of potentially avoidable readmission was acute heart failure. Patients with neoplasm, heart failure, and chronic kidney disease had a higher risk of potentially avoidable readmissions than did those without those comorbidities.
Conclusions The five most common primary diagnoses of potentially avoidable readmissions were usually possible complications of an underlying comorbidity. Post-discharge care should focus attention not just on the primary index admission diagnosis but also on the comorbidities patients have.
Introduction
Preventable readmissions to hospital are frequent, costly, and demanding on healthcare resources; they also represent threats to patients' safety such as preventable adverse drug events, healthcare associated infections, procedural complications, and avoidable exacerbations in disease states or functional declines. The recent focus on readmissions in some countries, including the United States, Germany, Switzerland, and England, driven in part by their effects on costs, thus underlies a much more global concern about patients' safety.
Hospital readmission represents a multifaceted problem that still needs to be better understood. Evidence shows that readmission diagnoses usually differ from the specific acute diagnosis responsible for the index hospital admission. On the other hand, higher comorbidity has been shown to be associated with an increased risk of readmission. Also, in a recent study, most of the 30 day readmissions after pneumonia were found to be comorbidity related. Thus, the role of comorbidities in causing readmissions is complex, but relatively few studies have looked at this. The subject will take on greater importance as a growing percentage of the world's population becomes older and the incidence of comorbidities rises.
A better understanding of the causes and patterns of readmissions in patients with common comorbidities may lead to more targeted and successful interventions, and these strategies may differ by condition. In addition, few data are available regarding to what extent the causes and patterns of all cause readmissions differ from the readmissions that are avoidable and thus actionable. We hypothesized that patients' comorbidities have an important role in the primary diagnosis of 30 day potentially avoidable readmission and that preventability of readmissions may vary among patients with different comorbidities. Therefore, our aim was to evaluate the primary diagnoses and patterns of 30 day readmissions and potentially avoidable readmissions according to the most common comorbidities in medical patients.
