Key result
Higher illness severity predicts ~31% greater 30-day readmission risk, while early post-discharge visits show no benefit.
Why the study?
Do severity of illness, risk of mortality, and post-discharge outpatient visits predict 30-day hospital readmissions?
Observational (n=55,532)
No
Do severity of illness, risk of mortality, and post-discharge outpatient visits predict 30-day hospital readmissions?
Severity of illness and risk of mortality significantly predict hospital readmission, whereas early post-discharge follow-up clinic visits do not appear to prevent readmissions.
SOI/ROM predict readmission risk; supports incorporation into models but leaves post-discharge visit effects open for prospective study.
BACKGROUND: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission. METHODS: Hospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated. RESULTS: A total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 % CI 1.25-1.38) and 1.09 (ROM: 95 % CI 1.05-1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed. CONCLUSIONS: SOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.
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Wang et al. (2016) conducted an observational in 30-day all-cause hospital readmission (n=55,532). Severity of illness (SOI) and risk of mortality (ROM) vs. Lower severity of illness and risk of mortality was evaluated on 30-day all-cause unplanned hospital readmission (OR 1.31, 95% CI 1.25-1.38, p=<0.05). Higher severity of illness and risk of mortality significantly predicted 30-day hospital readmission (adjusted OR 1.31 and 1.09, respectively), whereas early post-discharge clinic visits did not prevent readmissions.
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