Risk assessment of comorbidities on 30‐day avoidable hospital readmissions among internal medicine patients

• Published in: Journal of evaluation in clinical practice 2017-04, Vol.23 (2), p.391-401
• Main Authors: Hijazi, Heba H., Alyahya, Mohammad S., Hammouri, Hanan M., Alshraideh, Hussam A.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - organization & administration; Academic Medical Centers - statistics & numerical data; Adult; Aged; Comorbidity; diagnosis; Discharge; Disease management; Female; health care; Health risk assessment; health services research; Hospital Bed Capacity, 500 and over; Hospitalization; Humans; Internal Medicine; Jordan; Male; medical research; Middle Aged; multimorbidity; Patient admissions; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; public health; Quality of Health Care - organization & administration; Quantitative analysis; Retrospective Studies; Risk Assessment; Time Factors
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.12631

Rationale, aims and objectives: Reducing the rate of hospital readmissions, particularly avoidable ones, has significant implications on patient outcomes, cost containment, and quality of care. Given that the reason of readmission may differ from the patient's main diagnosis in the index admission, this study aims to assess the influence of index comorbidities on the primary readmission diagnoses and explore the risk of deemed avoidable readmission because of prior comorbidities. Methods: A retrospective review of 3962 discharges was conducted at a 527‐bed teaching hospital in Jordan, utilizing data related to 2025 internal medicine patients. Results: Among all discharges, 29% were followed by a 30‐day readmission, of which 13% were identified as potentially avoidable. Of all readmissions, 36% of patients were readmitted because of one of the comorbidities that had been identified at index admission. In addition, 47% of the potentially avoidable readmissions had a main diagnosis that was one of the index comorbidities. The results also showed an association between readmission for one of the index stay's comorbidities and being avoidable, with an adjusted odds ratio of 2.12 (95% confidence interval, 1.65‐2.72). Overall, the presence of certain diseases, being identified as one of the preceding comorbidities, was found to have a substantial influence on the risk of potentially avoidable readmission. These diseases included digestive, circulatory, respiratory, genitourinary systems, and infectious and parasitic diseases (adjusted relative risks = 1.57, 1.49, 1.36, 1.30, and 2.30, respectively). Conclusion: To help reduce the rates of readmission, potential gains seem available if hospitals adopt clinical practices that support the patient's care during the post‐discharge transition. This implies that health care providers need to pay more attention to the comorbidities of high‐risk patients to be closely monitored after discharge.