Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions

Hao Wang, Carol Johnson, Richard D. Robinson, Vicki Allene Nejtek, Chet D. Schrader, Jo Anna Leuck, Johnbosco Umejiego, Allison Trop, Kathleen A. Delaney, Nestor R. Zenarosa

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Abstract

Background: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission. Methods: Hospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated. Results: A total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 % CI 1.25-1.38) and 1.09 (ROM: 95 % CI 1.05-1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed. Conclusions: SOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalBMC Health Services Research
Volume16
Issue number1
DOIs
StatePublished - 10 Oct 2016

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Patient Readmission
Outpatients
Mortality
Ambulatory Care Facilities
Hospital Emergency Service
International Classification of Diseases
Ambulatory Care
Insurance Coverage
Patient Discharge
Diagnosis-Related Groups
Emergency Medical Services
Risk Reduction Behavior
Substance-Related Disorders
Prescriptions
Psychiatry
Length of Stay
Logistic Models
Odds Ratio
Demography

Keywords

  • APR-DRG
  • Hospital readmission
  • Post-discharge visit
  • Prediction

Cite this

Wang, Hao ; Johnson, Carol ; Robinson, Richard D. ; Nejtek, Vicki Allene ; Schrader, Chet D. ; Leuck, Jo Anna ; Umejiego, Johnbosco ; Trop, Allison ; Delaney, Kathleen A. ; Zenarosa, Nestor R. / Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions. In: BMC Health Services Research. 2016 ; Vol. 16, No. 1. pp. 1-10.
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title = "Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions",
abstract = "Background: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission. Methods: Hospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated. Results: A total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 {\%} CI 1.25-1.38) and 1.09 (ROM: 95 {\%} CI 1.05-1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed. Conclusions: SOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.",
keywords = "APR-DRG, Hospital readmission, Post-discharge visit, Prediction",
author = "Hao Wang and Carol Johnson and Robinson, {Richard D.} and Nejtek, {Vicki Allene} and Schrader, {Chet D.} and Leuck, {Jo Anna} and Johnbosco Umejiego and Allison Trop and Delaney, {Kathleen A.} and Zenarosa, {Nestor R.}",
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Wang, H, Johnson, C, Robinson, RD, Nejtek, VA, Schrader, CD, Leuck, JA, Umejiego, J, Trop, A, Delaney, KA & Zenarosa, NR 2016, 'Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions', BMC Health Services Research, vol. 16, no. 1, pp. 1-10. https://doi.org/10.1186/s12913-016-1814-7

Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions. / Wang, Hao; Johnson, Carol; Robinson, Richard D.; Nejtek, Vicki Allene; Schrader, Chet D.; Leuck, Jo Anna; Umejiego, Johnbosco; Trop, Allison; Delaney, Kathleen A.; Zenarosa, Nestor R.

In: BMC Health Services Research, Vol. 16, No. 1, 10.10.2016, p. 1-10.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions

AU - Wang, Hao

AU - Johnson, Carol

AU - Robinson, Richard D.

AU - Nejtek, Vicki Allene

AU - Schrader, Chet D.

AU - Leuck, Jo Anna

AU - Umejiego, Johnbosco

AU - Trop, Allison

AU - Delaney, Kathleen A.

AU - Zenarosa, Nestor R.

PY - 2016/10/10

Y1 - 2016/10/10

N2 - Background: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission. Methods: Hospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated. Results: A total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 % CI 1.25-1.38) and 1.09 (ROM: 95 % CI 1.05-1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed. Conclusions: SOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.

AB - Background: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission. Methods: Hospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated. Results: A total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 % CI 1.25-1.38) and 1.09 (ROM: 95 % CI 1.05-1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed. Conclusions: SOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.

KW - APR-DRG

KW - Hospital readmission

KW - Post-discharge visit

KW - Prediction

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U2 - 10.1186/s12913-016-1814-7

DO - 10.1186/s12913-016-1814-7

M3 - Article

VL - 16

SP - 1

EP - 10

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

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