The Role of Patient Characteristics in Reducing 30-day Hospital Readmissions

Abstract

Specific Aims: The purpose of this study was to determine what characteristics are most often associated with patients who are readmitted to a hospital for care within a 30-day time period for one of the five applicable conditions listed in the Hospital Readmissions Reduction Program, including heart failure, pneumonia, myocardial infarct, vascular procedures, and chronic obstructive pulmonary disease. Methods: This study was a retrospective chart review of patients who had a 30-day inpatient hospital readmission to a tertiary referral teaching hospital in Tucson, Arizona during the period from January 1, 2012 to June 30, 2012. Patient demographics and other characteristics thought to influence readmission were collected, including sex, age, race, type of insurance, number of applicable diagnoses at first admission, and number of medications prescribed at first discharge. “Applicable diagnoses” included: congestive heart failure (CHF); pneumonia (PN); myocardial infarct (MI); vascular procedures (VP); and chronic obstructive pulmonary disease (COPD). Main Results: Of the 1,102 patients included in this study, only 5% were readmitted for one of the five applicable conditions. The largest proportion of patients who were readmitted for the same diagnosis were in the 21 to 40 year old category, whereas the largest proportion of patients who were readmitted for different diagnoses were in the greater than 40 year-old category. The results of the multiple regression analysis showed that none of the independent variables predicted 30-day readmissions with the exception of Asian race (p=0.008, n=8) and other race (p=0.012, n=57). In addition, the only significant predictor of 30-day readmission was the diagnosis at initial admission (p<0.05). Conclusion: In our sample, only 5% of patients readmitted at 30-days were readmitted for an applicable condition. This means the majority of readmissions include diagnoses that are not currently affected by the changes to Medicare reimbursement, though other diagnoses are likely to be added to the list in the coming years. Our study provides evidence that specific patient demographic characteristics are not closely linked to 30-day readmissions. Therefore, it may be necessary to turn the focus away from targeting specific patient populations and towards improving efforts in the areas of discharge planning and quality of care for all patients.