Thirty-Day, All-cause Readmissions for Elderly Patients Who Have an Injury-related Inpatient Stay

• Published in: Medical care Vol. 50; no. 10; pp. 863 - 869
• Main Authors: Spector, William D., Mutter, Ryan, Owens, Pamela, Limcangco, Rhona
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-10-2012; Lippincott Williams & Wilkins, Inc; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Age Factors; Aged; Aged, 80 and over; Comorbidity; Female; Hip fractures; Hospital Administration - statistics & numerical data; Hospital admissions; Hospitalization; Hospitals; Hospitals, Community - statistics & numerical data; Humans; Infections; Injuries; Inpatient care; Male; Medical diagnosis; Medicare; Nonprofit hospitals; Older adults; Older people; Patient admissions; Patient Readmission - statistics & numerical data; Physical trauma; Pneumonia; Retrospective Studies; Sex Factors; Socioeconomic Factors; Time Factors; Trauma Severity Indices; United States - epidemiology; Wounds and Injuries - epidemiology; United States
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0b013e31825f2840

Background: Policymakers are exploring ways to reduce readmission rates. Much attention has been given to readmissions for conditions such as heart failure, acute myocardial infarction, and pneumonia, but little attention has been given to readmissions of patients with injury-related index admissions. Methods: This analysis is a retrospective cohort study of elderly persons who are admitted to a community hospital for a principal diagnosis of injury. We use 2006 Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from 11 States. With logistic regression we identify factors associated with a 30-day, all-cause inpatient readmission. Factors include: patient characteristics, injury characteristics, clinical experiences during the hospital stay, and hospital characteristics. Results: About 1 in 7 elderly patients with an injury-related admission were readmitted in 30 days (13.7%). We found that severe injuries had higher predicted readmission rates. Patients receiving transfusions, experiencing a Patient Safety Indicator event, and with infections had higher readmission rates. Patients discharged to nursing homes or home health care had higher readmission rates compared with patients discharged to the community. Conclusions: This study expands evidence for the influence of injury characteristics on readmission rates. It also provides evidence about hospital experiences that affect readmissions. These findings suggest that a focus on preventing complications during the hospital stay may help reduce hospital-specific readmissions for patients with injury-related conditions. It also suggests that a strategy to reduce readmission rates should not only focus on hospitals but also nursing homes and home health care.