Abstract
BackgroundStudies on readmissions attributed to particular medical conditions, especially heart failure, have generally not addressed the factors associated with readmissions and the implications for health outcomes and costs. This study aimed to investigate the factors associated with 30-day unplanned readmission for 10 common conditions and to determine the cost implications.MethodsThis population-based retrospective cohort study included patients admitted to all public hospitals in Hong Kong in 2007. The sample consisted of 337,694 hospitalizations in Internal Medicine. The disease-specific risk-adjusted odd ratio (OR), length of stay (LOS), mortality and attributable medical costs for the year were examined for unplanned readmissions for 10 medical conditions, namely malignant neoplasms, heart diseases, cerebrovascular diseases, pneumonia, injury and poisoning, nephritis and nephrosis, diabetes mellitus, chronic liver disease and cirrhosis, septicaemia, and aortic aneurysm.ResultsThe overall unplanned readmission rate was 16.7%. Chronic liver disease and cirrhosis had the highest OR (1.62, 95% confidence interval (CI) 1.39-1.87). Patients with cerebrovascular disease had the longest LOS, with mean acute and rehabilitation stays of 6.9 and 3.0 days, respectively. Malignant neoplasms had the highest mortality rate (30.8%) followed by aortic aneurysm and pneumonia. The attributed medical cost of readmission was highest for heart disease (US$3 199 418, 95% CI US$2 579 443-803 393).ConclusionsOur findings showed variations in readmission rates and mortality for different medical conditions which may suggest differences in the quality of care provided for various medical conditions. In-hospital care, comprehensive discharge planning, and post-discharge community support for patients need to be reviewed to improve the quality of care and patient health outcomes.
Highlights
Studies on readmissions attributed to particular medical conditions, especially heart failure, have generally not addressed the factors associated with readmissions and the implications for health outcomes and costs
Hospital readmission rates have been proposed as an important indicator of patient health outcome and healthcare system performance [1,2,3,4], and they are regarded as an indicator of poor care or a lack of coordination of care services
There is literature on readmissions attributed to particular medical conditions, especially heart failure, few of these studies addressed the broader issues involving the impact of variations in disease conditions on readmission, and the implications on health outcomes and costs
Summary
Studies on readmissions attributed to particular medical conditions, especially heart failure, have generally not addressed the factors associated with readmissions and the implications for health outcomes and costs. Several reports suggested that programs aimed at reducing readmission rates should focus on those conditions at high risk of readmission [12,16,17,18,19]. A number of studies suggested that a focus on patients with defined medical conditions would yield a higher reward in terms of reducing readmissions in the general inpatient population [27]. There is literature on readmissions attributed to particular medical conditions, especially heart failure, few of these studies addressed the broader issues involving the impact of variations in disease conditions on readmission, and the implications on health outcomes and costs
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