Abstract
BackgroundEarly readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital.MethodsThis is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term.ResultsParticipants (n = 674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR = 0.47, 95% CI 0.26–0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR = 0.35, 95% CI 0.16–0.76) but increased likelihood of readmission or death among Whites (AOR = 3.7, 95% CI 1.07–12.9).ConclusionIn older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients’ social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study.Trial registrationNIH trials registry number ClinicalTrials.gov: NCT01221532.
Highlights
Readmission amongst older safety-net hospitalized adults is costly
We excluded participants who were [1]: transferred from an outside hospital [2]; admitted as a planned hospitalization [3]; likely to be discharged to an institutional setting [4]; unable to consent due to lack of understanding, cognitive impairment, or other reason [5]; diagnosed with metastatic cancer; and [6] unable to participate in telephone follow-up
Among ethnically diverse, older adults hospitalized at a safety-net hospital, we found that those with high perceived social support had lower rates of 30-day readmission and death
Summary
Readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The Center for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program has focused attention on preventing 30-day hospital readmissions [2], spurring development of transitional care interventions. These studies show mixed results [3,4,5,6,7], in safety-net settings with higher proportions of racial/ethnic minorities, non-English speakers, and patients with lower socioeconomic status [8]. Known clinical risk factors associated with early readmission include history of recent prior hospitalization, high burden of comorbid illness and specific diagnoses [9]. According to Andersen’s Behavioral Model of Health Services Use, predisposing factors (eg. demographics, health beliefs), enabling resources (eg. access to care, social support), in addition to need (eg. clinical status) influence utilization [11]
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