30-Day Potentially Preventable Hospital Readmissions In Older Patients: Clinical Phenotype And Health Care Related Risk Factors
Received 30 March 2019
Accepted for publication 21 July 2019
Published 5 November 2019 Volume 2019:14 Pages 1851—1858
Checked for plagiarism Yes
Review by Single-blind
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
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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