Original article
Risk factors for hospital readmission of elderly patients

https://doi.org/10.1016/j.ejim.2012.10.005Get rights and content

Abstract

Background

The aim of this study was to identify which factors were associated with a risk of hospital readmission within 3 months after discharge of a sample of elderly patients admitted to internal medicine and geriatric wards.

Methods

Of the 1178 patients aged 65 years or more and discharged from one of the 66 wards of the ‘Registry Politerapie SIMI (REPOSI)’ during 2010, 766 were followed up by phone interview 3 months after discharge and were included in this analysis. Univariate and multivariate logistic regression models were used to evaluate the association of several variables with rehospitalization within 3 months from discharge.

Results

Nineteen percent of patients were readmitted at least once within 3 months after discharge. By univariate analysis in-hospital clinical adverse events (AEs), a previous hospital admission, number of diagnoses and drugs, comorbidity and severity index (according to Cumulative Illness Rating Scale-CIRS), vascular and liver diseases with a level of impairment at discharge of 3 or more at CIRS were significantly associated with risk of readmission. Multivariate logistic regression analysis showed that only AEs during hospitalization, previous hospital admission, and vascular and liver diseases were significantly associated with the likelihood of readmission.

Conclusions

The results demonstrate the need for increased medical attention towards elderly patients discharged from hospital with characteristics such as AEs during the hospitalization, previous admission, vascular and liver diseases.

Introduction

Hospital readmission within a short time from discharge is a common occurrence in the daily practice of internal medicine wards [1], [2]. Some studies documented that the decrease in the rate of readmission is important in order to improve quality of care and reduce costs [3], [4]. Different rates of readmissions have been found between hospitals and geographical areas [5], [6] and several risk factors and combinations thereof have been proposed in order to identify patients at risk to be rehospitalized [7], [8], [9]. In the last few years, due to cost containment physicians are often prompted to minimize the length of hospital stay. Shortening of hospitalization length is a factor often associated to a higher risk of readmission [10], with the paradoxical effects of decreasing the quality of care and increasing secondary expenses due to the incomplete patient recovery. For this reason it has been suggested that high and rising readmission rates may be “the price of early discharge” [11]. Older people are at increased risk of hospital readmissions, so that a number of studies have chosen to study the risk factors of hospital readmission in the elderly [9]. For instance, Silverstein et al. conducted a retrospective cohort study of people aged 65 or older using administrative data of seven acute care hospitals in order to develop predictors of 30-day readmission [7], but fewer studies focused their attention on predictors of later hospital readmission in the elderly [12]. The aim of this study was to analyze which factors are associated with an increased risk of readmissions within 3 months of the index date of discharge of a cohort of 65 years or older patients evaluated in the frame of the network of Italian internal medicine and geriatric wards participating in 2010 in the Registro Politerapie SIMI (REPOSI).

Section snippets

Study setting, design and patient population

This study was conducted in 66 hospital wards representative of the Italian internal and geriatric medicine wards, participating in the ‘Registro Politerapie SIMI’ (REPOSI). The REPOSI is a collaborative and independent study of the Italian Society of Internal Medicine (SIMI) and the Mario Negri Institute of Pharmacological Research. The design was described in details elsewhere [13]. In brief, patients aged 65 years or older consecutively admitted to hospital during four periods that lasted

Results

Of the 1380 enrolled patients, a total of 1178 (85%) were discharged alive from the participating wards. The 3 month follow-up information was obtained from 832 (70%) of them. During the 3 months of follow-up, 66 (7.9%) patients died, thus 766 patients were ultimately included in the analysis: 145 of them (19%) were readmitted at least once within 3 months from the index date of discharge (rehospitalized group), the remaining 621 patients were the non-rehospitalized group (Fig. 1). Among the

Discussion

In this study the rate of hospital readmission within 3 months from discharge (19%) was slightly lower than the results of a previous study conducted in elderly patients (23%) [12], and than those of the study of Jencks et al. (34%) conducted in patients not selected for age in the frame of Medicare [3]. Our rate is almost equal to that of Maurer et al. (20%), who performed a pilot study in patients recruited by internal medicine wards in Switzerland [6].

According to the literature, there are

Learning points

  • 19% of patients discharged from a representative sample of Italian internal medicine and geriatric wards were rehospitalized at least once within 3 months.

  • There was no significant association between some sociodemographic and clinical characteristics (length of stay, cognitive, functional and depression status) and probability of readmission.

  • New adverse clinical events that had occurred during index hospitalization, prior hospital admission, illness severity and vascular and liver diseases with

Conflict of interests

The authors state that they have no conflicts of interest.

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    1

    REPOSI denotes Registry of Polytherapies SIMI (Società Italiana di Medicina Interna).

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