Abstract
Background/PurposeEarly unplanned hospital readmissions are burdensome health care events and indicate low care quality. Identifying at-risk patients enables timely intervention. This study identified predictors for 14-day unplanned readmission.MethodsWe conducted a retrospective, matched, case–control study between September 1, 2018, and August 31, 2019, in an 1193-bed university hospital. Adult patients aged ≥ 20 years and readmitted for the same or related diagnosis within 14 days of discharge after initial admission (index admission) were included as cases. Cases were 1:1 matched for the disease-related group at index admission, age, and discharge date to controls. Variables were extracted from the hospital’s electronic health records.ResultsIn total, 300 cases and 300 controls were analyzed. Six factors were independently associated with unplanned readmission within 14 days: previous admissions within 6 months (OR = 3.09; 95 % CI = 1.79–5.34, p < 0.001), number of diagnoses in the past year (OR = 1.07; 95 % CI = 1.01–1.13, p = 0.019), Malnutrition Universal Screening Tool score (OR = 1.46; 95 % CI = 1.04–2.05, p = 0.03), systolic blood pressure (OR = 0.98; 95 % CI = 0.97–0.99, p = 0.01) and ear temperature within 24 h before discharge (OR = 2.49; 95 % CI = 1.34–4.64, p = 0.004), and discharge with a nasogastric tube (OR = 0.13; 95 % CI = 0.03–0.60, p = 0.009).ConclusionsFactors presented at admission (frequent prior hospitalizations, multimorbidity, and malnutrition) along with factors presented at discharge (clinical instability and the absence of a nasogastric tube) were associated with increased risk of early 14-day unplanned readmission.
Highlights
Hospital readmissions disrupt the normal lives of families and caregivers, cause patient discomfort, and increase overall health care costs [1,2,3]
Recent studies have shown that early readmissions within the first 7 days of hospital discharge may be more preventable than later 30-day readmissions are [8, 13, 14], and they are more indicative of potential gaps in care during the index hospitalization [13, 15]
In this study, we found that predictors of early 14-day unplanned readmission were nonclinical with clinical factors presented at initial admission and clinical factors presented at discharge
Summary
Hospital readmissions disrupt the normal lives of families and caregivers, cause patient discomfort, and increase overall health care costs [1,2,3]. An approach to reducing the hospital readmission rate is identifying patients at risk of readmission, which allows for further investigation and development of preventive strategies because many readmissions are considered preventable [8, 9]. Diverse and complex factors lead to readmissions, and clinicians are unable to process information to accurately identify at-risk patients [10]. Studies have suggested various risk factors for 30-day readmission, including age, social determinants, Charlson Comorbidity Index, prior health care utilization patterns, emergent admission, laboratory data including hemoglobin and sodium levels, discharge from an oncological service, procedures during the index admission (first admission), and length of hospital stay [11, 12]. Studies have demonstrated a variation in the strength of unplanned 7-day and 30-day readmission predictors [14, 15]. Whether risk factors of 14-day unplanned hospital readmissions vary from those of 7-day or 30-day unplanned readmissions has not been thoroughly investigated
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