Abstract
Background: Hospital readmission rates are increasingly used as a measure of healthcare quality. Medicines are the most common therapeutic intervention but estimating the contribution of adverse drug events as a cause of readmissions is difficult. Objectives: To assess the prevalence and preventability of medication-related readmissions within 30 days after hospital discharge and to describe the risk factors, type of medication errors and types of medication involved in these preventable readmissions. Design: A cross-sectional observational study. Setting: The study took place across the cardiology, gastroenterology, internal medicine, neurology, psychiatry, pulmonology and general surgery departments in the OLVG teaching hospital, Netherlands. Participants: Patients with an unplanned readmission within 30 days after discharge from an earlier hospitalization (index hospitalization: IH) were reviewed. Measurements: The prevalence and preventability of medication-related readmissions were assessed by residents in multidisciplinary meetings. A senior internist and hospital pharmacist reassessed the prevalence and preventability of identified cases. Generalized estimating equation with logistic regression was performed to identify risk factors of potentially preventable medication-related readmissions. Results: Of 1,111 included readmissions, 181 (16%) were medication-related, of which 72 (40%) were potentially preventable. The number of medication changes at IH (Adjusted odds ratio [ORadj]: 1.14; 95% CI: 1.05–1.24) and having ≥3 hospitalizations 6 months before IH (ORadj: 2.11; 95% CI: 1.12–3.98) were risk factors of a preventable medication-related readmission. Of these preventable readmissions, 35% were due to prescribing errors, 35% by non-adherence and 30% by transition errors. Medications most frequently involved were diuretics and antidiabetics. Conclusion: This study shows that 16% of readmissions are medication-related, of which 40% are potentially preventable. If the results are confirmed in larger multicentre studies, this may indicate that more attention should be paid to medication-related harm in order to lower the overall readmission rates.
Highlights
Unplanned hospital readmissions within 30 days are increasingly used as a measure of healthcare quality
The type of medication errors involved in preventable medication-related readmissions were unclear and there is a focus on prescribing errors, whereas other medication errors may be important, such as non-adherence (El Morabet et al, 2018; Parekh et al, 2018)
This study aims to assess the prevalence and preventability of medication-related readmissions within 30 days of discharge, potential risk factors associated with preventable medication-related readmissions, the types of medication errors and the medications involved in those readmissions are assessed
Summary
Unplanned hospital readmissions within 30 days are increasingly used as a measure of healthcare quality. Previous studies show that approximately 20% of patients discharged from hospital are readmitted within 30 days of discharge (Jencks et al, 2009) and 5–79% of those readmissions are estimated to be preventable (median: 27%) (Van Walraven et al, 2011). Previous studies on the impact of medication on (preventable) hospital readmissions have some methodological flaws (El Morabet et al, 2018). Six studies have determined the preventability of medication-related readmissions and in only two of these was the preventability assessed by a multidisciplinary method (Ruiz et al, 2008; Rothwell et al, 2011), despite the fact that a multidisciplinary review is recommended (van Doormaal et al, 2008). Medicines are the most common therapeutic intervention but estimating the contribution of adverse drug events as a cause of readmissions is difficult
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