Abstract
BackgroundHigh-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we propose that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality.MethodsWe extracted data from our transitional care program (TCP), a Hospital-to-Home program launched by the Singapore Ministry of Health, from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality.ResultsAmong 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but largely physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p < 0.05), 30- and 90-day readmission (p < 0.05) and mortality (p < 0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR = 2.04, 95%CI: 1.21–3.46, p = 0.008), 30- (OR = 6.92, 95%CI: 1.76–27.21, p = 0.006) and 90-day mortality (OR = 11.51, 95%CI: 4.57–29.02, p < 0.001).ConclusionsWe identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.
Highlights
High-risk patients are most vulnerable during transitions of care
Brief summary High-risk healthcare utilizers were segmented into 3 classes, with Class 1 “Frail, cognitively impaired and physically dependent” having the highest 90-day hospital readmission and 30- and 90-day mortality
The Singapore Ministry of Health (MOH) launched the Hospital-to-Home (H2H) program [8], a transitional care program (TCP) that aims to improve the transition from acute care settings back into the community [9]
Summary
High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we propose that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. Healthcare systems are facing the challenge of an ageing population with multiple chronic conditions [1] These patients often experience repeated hospitalizations and are vulnerable during transitions of care, resulting in significant hospital readmissions, mortality and healthcare expenditure [2, 3]. In Singapore, a multi-ethnic nation of 5.6 million people [4] with one of the most rapidly ageing population in Asia, the 30-day all-cause readmission rates in 2010 was 11.6% [5], which increased to 19.0% for patients aged 65 years and older. This is slightly lower than the 19.6% 30day readmission rate in the United States [6]. Similar programs emphasising population health management have emerged amongst health systems worldwide to understand the determinants of health and deliver solutions to this emerging problem [10]
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