Key result
Quality of care factors were significantly more prevalent among older medical patients with unplanned 30-day readmissions compared to non-readmitted controls (44.3% vs 11.6%, P<0.001).
Case-Control (n=311)
No
Absolute Event Rate: 44.3% vs 11.6%
p-value: p=<0.001
Quality of care factors, such as failure to develop advance care plans and suboptimal management, are significantly associated with 30-day unplanned readmissions in older medical patients.
Quality-of-care deficits may contribute to readmissions in older adults; hypothesis-generating and requires prospective confirmation before practice change.
BACKGROUND: Unplanned readmissions befall up to 25% of acutely hospitalised older patients, and many may be potentially preventable. AIM: To assess the type and prevalence of quality of care factors associated with potentially preventable readmissions to a tertiary hospital general medicine service. METHODS: A retrospective case-control study was undertaken of hospital records of patients 65 years or older admitted acutely between 1 January 2005 and 31 December 2010. Readmissions up to 30 days postdischarge (cases) were purposively sampled according to frequencies of primary discharge diagnoses coded during the study period. Non-readmitted patients (controls), matched according to age, sex and primary discharge diagnosis on index admission, were selected in a 1.7:1 ratio. RESULTS: One hundred and thirteen cases and 198 controls were analysed, the former demonstrating a significantly higher comorbidity burden (mean (±standard deviation) comorbidity score 6.6 (±2.2) vs 5.6 (±2.4), P = 0.003) and a higher proportion of individuals with one or more hospitalisations over the preceding 6 months (55.7% vs 8.1%, P < 0.001). Among readmitted patients, 50 (44.3%) were associated with one or more quality factors versus 23 (11.6%) controls (P < 0.001). The most common were: failure to develop/activate an advance care plan (18, 15.9% vs 2, 1.0%; P < 0.001); suboptimal management of presenting illness (13, 11.4% vs 0, 0%; P < 0.001); inadequate assessment of functional limitations (11, 9.7% vs 0, 0%; P < 0.001); and potentially preventable complication of therapy (8, 7.1% vs 1, 0.5%, P = 0.002). CONCLUSIONS: Quality of care factors are more common among readmitted than among non-readmitted older patients suggesting potential for remedial strategies. Such strategies may still have limited effects as older, frail patients with advanced diseases and multimorbidity will likely retain a high propensity for readmission despite optimal care.
No takes yet. Share an insight, caveat, or question.
Scott et al. (2013) conducted a case-control in Unplanned hospital readmissions (n=311). Quality of care factors vs. Non-readmitted patients (controls) was evaluated on Presence of one or more quality of care factors (p=<0.001). Quality of care factors were significantly more prevalent among older medical patients with unplanned 30-day readmissions compared to non-readmitted controls (44.3% vs 11.6%, P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: