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Epidemiology
Research
Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study
  1. Yogesh Sharma1,2,
  2. Michelle Miller3,
  3. Billingsley Kaambwa4,
  4. Rashmi Shahi5,
  5. Paul Hakendorf6,
  6. Chris Horwood6,
  7. Campbell Thompson7
  1. 1 Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
  2. 2 College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  3. 3 Department of Nutrition and Dietetics, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
  4. 4 Health Economics Unit, Flinders University, Adelaide, South Australia, Australia
  5. 5 Faculty of Health Sciences, Flinders University, Adelaide, South Australia, Australia
  6. 6 Department of Clinical Epidemiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
  7. 7 Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Dr Yogesh Sharma; Yogesh.Sharma{at}sa.gov.au

Abstract

Objectives Limited studies have identified predictors of early and late hospital readmissions in Australian healthcare settings. Some of these predictors may be modifiable through targeted interventions. A recent study has identified malnutrition as a predictor of readmissions in older patients but this has not been verified in a larger population. This study investigated what predictors are associated with early and late readmissions and determined whether nutrition status during index hospitalisation can be used as a modifiable predictor of unplanned hospital readmissions.

Design A retrospective cohort study.

Setting Two tertiary-level hospitals in Australia.

Participants All medical admissions ≥18 years over a period of 1 year.

Outcomes Primary objective was to determine predictors of early (0–7 days) and late (8–180 days) readmissions. Secondary objective was to determine whether nutrition status as determined by malnutrition universal screening tool (MUST) can be used to predict readmissions.

Results There were 11 750 (44.8%) readmissions within 6 months, with 2897 (11%) early and 8853 (33.8%) late readmissions. MUST was completed in 16.2% patients and prevalence of malnutrition during index admission was 31%. Malnourished patients had a higher risk of both early (OR 1.39, 95% CI 1.12 to 1.73) and late readmissions (OR 1.23, 95% CI 1.06 to 128). Weekend discharges were less likely to be associated with both early (OR 0.81, 95% CI 0.74 to 0.91) and late readmissions (OR 0.91, 95% CI 0.84 to 0.97). Indigenous Australians had a higher risk of early readmissions while those living alone had a higher risk of late readmissions. Patients ≥80 years had a lower risk of early readmissions while admission to intensive care unit was associated with a lower risk of late readmissions.

Conclusions Malnutrition is a strong predictor of unplanned readmissions while weekend discharges are less likely to be associated with readmissions. Targeted nutrition intervention may prevent unplanned hospital readmissions.

Trial registration ANZCTRN 12617001362381; Results.

  • quality in health care
  • internal medicine
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2018-022246

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    Footnotes

    • Contributors YS and CT designed and led the study. YS, CT, PH and CH carried out the analysis and interpretation. CH was responsible for data acquisition. YS, PH and CH provided statistical input. YS wrote the manuscript, which was critically reviewed by CT. CT, BK, RS and MM edited the manuscript. All authors approved final manuscript.

    • Funding This work was supported by Flinders Centre for Clinical Change and Health Care Research (FCCCHCR) collaboration grant from Flinders University, South Australia (grant number: 36373)

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC) no. 216.17

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data that support the findings of this study are available from the corresponding author upon reasonable request and only after permission by the Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC).