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

Authors Calsolaro V, Antognoli R, Pasqualetti G, Okoye C, Aquilini F, Cristofano M, Briani S, Monzani F

Received 30 March 2019

Accepted for publication 21 July 2019

Published 5 November 2019 Volume 2019:14 Pages 1851—1858

DOI https://doi.org/10.2147/CIA.S208572

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker


Valeria Calsolaro,1,* Rachele Antognoli,1,* Giuseppe Pasqualetti,1 Chukwuma Okoye,1 Ferruccio Aquilini,2 Michele Cristofano,2 Silvia Briani,2 Fabio Monzani1

1Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy; 2Health Management Department, University Hospital of Pisa, Pisa, Italy

*These authors contributed equally to this work

Correspondence: Fabio Monzani
Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, via Paradisa 2, Pisa 56124, Italy
Tel +39 3337733135
Email fabio.monzani@med.unipi.it

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


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