Hospital Readmissions Driven by Length of Stay, Smoking, Comorbidities


A retrospective review of rural region's hospitals found that even the discharge time of day could be associated with a greater chance of readmission.

hospital readmissions

In observed hospital data from a rural region involving patients admitted with pulmonological conditions, investigators found that readmission was 2.9% more likely for every day the patient spent in the hospital.

The retrospective review, to be presented at the 2018 CHEST Annual Meeting in San Antonio, TX, targeted the rural Southern Appalachia region due to its above-average rates of hospital readmissions.

The team, led by Christine Moore, DO, of the East Tennessee State University, Quillen College of Medicine, also sought to address the healthcare trend which generally costs hospitals about $26 billion annually. With projects such as the Affordable Care Act’s Hospital Readmission Reduction Program implementing penalties to hospitals with greater readmission rates in patients with targeted diagnoses, it is even more critical for regions such as Southern Appalacachia to assess its flaws in care.

Investigators reviewed 15,500 patients who were admitted at regional hospitals between January 1, 2014 and October 31, 2017. The conducted univariate analyses on independent variables such as length of stay, age, gender, healthcare payor, time and date of discharge, tobacco use, smoking cessation education, medication reconciliation upon discharge, and the presence of co-morbid diagnoses.

Co-morbid diagnoses targeted in analysis included diabetes mellitus (DM), hypertension (HTN), chronic renal failure (CRF), and psychiatric disorders. Using a multiple logistic regression model with backwards elimination, investigators prioritized for a .05 statistical significance.

Based on the regression model, investigators reported that readmission likelihood increased by 2.9% (95% CI: 1.018 — 1.04; P < .0001) for every day of stay. They also reported a significance in discharge time-of-day: patients discharged between 1 am and 1 pm were less likely to be readmitted than those discharged between 1 pm and 1 am (P < .0001). Assessing for the date of readmission was less conclusive—only patients discharged in March (P = .0149) or August (P = .0183) were less likely to be readmitted when compared to patients discharged in January.

Former smokers were more likely to be readmitted than those who never smoked (P = .0002), and patients who were provided smoking cessation education discharge were less likely to be readmitted (P = .0309).

Diagnoses of COPD, DM, HTN, and CRF were all associated with increased readmission likelihood (P < .0001), as did a psychiatric disorder diagnosis (P = .0121).

There was no statistically significant association based on age, gender, or healthcare payor, nor was there any for weekday of discharge or medication reconciliation at initial hospital discharge.

Investigators concluded there were a series of findings to pursue—namely, the increased readmission rate of patients who have smoked, been diagnosed with a comorbidity or psychiatric disorder, have been discharged in the afternoon, or who have an increased length of stay to start.

“Some methods to prevent readmissions are decreasing length of stay, discharging patients before 1300, providing smoking cessation education, and controlling comorbid diagnoses,” Moore said.

The study, “Causes and Preventions of Hospital Readmissions: Comparing National Trends to Rural Southern Appalachia,” will be presented at CHEST 2018.

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