Key result
Frailty-related diagnoses increased the risk of 30-day readmission (overall mean adjusted rate 18.3%), whereas incident high-risk medication use and prior primary care visits lowered readmission risk.
Why the study?
Do frailty-related diagnoses, high-risk medications, and primary care visit volume affect 30-day readmission rates in elderly veterans?
Cohort
Yes
Do frailty-related diagnoses, high-risk medications, and primary care visit volume affect 30-day readmission rates in elderly veterans?
Frailty-related diagnoses and fewer primary care visits are associated with higher 30-day readmission risk in elderly veterans, suggesting targets for care transition services.
Answers are grounded in this paper and cite their sources.
Supports frailty and primary care as readmission risk modifiers in elderly veterans; hypothesis-generating and should not yet change practice.
OBJECTIVES: To determine the effect of two variables not previously studied in the readmissions literature (frailty-related diagnoses and high-risk medications in the elderly (HRME)) and one understudied variable (volume of primary care visits in the prior year). DESIGN: Retrospective cohort study using data from a study designed to examine outcomes associated with inappropriate prescribing in elderly adults. SETTING: All Veterans Affairs (VA) facilities with acute inpatient beds in fiscal year 2006 (FY06). PARTICIPANTS: All veterans aged 65 and older by October 1, 2005, who received VA care at least once per year between October 1, 2004, and September 30, 2006, and were hospitalized at least once during FY06 on a medical or surgical unit. MEASUREMENTS: A generalized linear interactive risk prediction model included demographic and clinical characteristics (mental health and chronic medical conditions, frailty-related diagnoses, number of medications) in FY05; incident HRME in FY06 before index hospitalization or readmission; chronic HRME in FY05; and FY05 emergency department (ED), hospital, geriatric, palliative, or primary care use. Facility-level variables were complexity, rural versus urban, and FY06 admission rate. RESULTS: The mean adjusted readmission rate was 18.3%. The new frailty-related diagnoses variable is a risk factor for readmission in addition to Charlson comorbidity score. Incident HRME use was associated with lower rates of readmission, as were higher numbers of primary care visits in the prior year. CONCLUSION: Frailty-related diagnoses may help to target individuals at higher risk of readmission to receive more-intensive care transition services. HRME use does not help in this targeting. A higher number of face-to-face primary care visits in the prior year, unlike ED and hospital use, correlates with fewer readmissions and may be another avenue for targeting prevention strategies.
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Pugh et al. (2014) conducted a cohort in Hospitalized veterans. Frailty-related diagnoses, high-risk medications, and primary care visits was evaluated on Readmission in fewer than 30 days. Frailty-related diagnoses increased the risk of 30-day readmission (overall mean adjusted rate 18.3%), whereas incident high-risk medication use and prior primary care visits lowered readmission risk.
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