Which factors predict unscheduled 30-day hospital readmissions?

Thirty-day readmissions are associated with several patient-, hospital-, and system-related factors, which may be used to identify at-risk patients early, according to a Singapore study.

“[O]ur study identified several factors related to patient (eg, diagnosis, age, sex, ethnicity, comorbidity, subvention, visit to emergency department), procedure/medical (eg, number of surgeries, number of discharge medications), and hospital (eg, length of stay, bill size) to be associated [with readmissions],” the researchers said, adding that qualitative data indicated the “vulnerability of readmitted patients, their negative emotions, and feeling of uselessness to the family and society at large.”

In this concurrent nested, mixed-method study, the researchers examined several factors associated with patients (n=104,496) readmitted within 30 days between 2011 and 2015 at the National University Hospital in Singapore. They sampled 50 patients in 2016 to inform an embedded qualitative study. In addition, narrative interviews were carried out to explore the periods of readmissions and related experiences as opposed to those of nonreadmitted patients.

The most significant factors associated with readmissions were neoplastic disease (odds ratio [OR], 1.91, 95 percent confidence interval [C], 1.70–2.15), number of discharged medications (five to 10 medications: OR, 1.21, 95 percent CI, 1.14–1.29; ≥11 medications: OR, 1.80, 95 percent CI, 1.66–1.95), and length of stay >7 days (OR, 1.46, 95 percent CI, 1.36–1.58). [Ann Acad Med Singap 2021;doi:10.47102/annals-acadmedsg.2020522]

Other factors independently associated with hospital readmissions included age, gender, ethnicity, number of surgical operations, subvention class, number of emergency department visits in the previous year, hospital bill size, and Charlson comorbidity index.

Previous studies confirmed some of these risk factors, including length of stay during the index admission and number of emergency department visits in the last year. [CMAJ 2010;182:551-557; JAMA Intern Med 2013;173:632-638]

Some common experiences were also shared by both readmitted and nonreadmitted patients, but they differed in psychological reactions to their illnesses and views concerning hospital care. In addition, readmitted patients expressed negative emotions, feeling of being left out by the healthcare team, and perception of ineffective or inappropriate treatment.

Of note, finances were not often a barrier to seek care for both readmitted and nonreadmitted patients. Significant differences between patient accounts revolved around hospitalization experiences, as well as respective positive versus negative internalization of the “patient role” (self-efficacy in recovery as opposed to feeling like a burden).

“Understanding that discharged patients may remain in vulnerable health conditions, both physically and psychologically even after their hospital stay—a phenomenon termed ‘posthospital syndrome’—is an important aspect of the changed healthcare scenario,” the researchers said. “Unless sufficient support is given to these patients, inability to cope with the burden of discharge may lead to readmissions.” [JAMA Intern Med 2014;174:1095-1107]

The researchers identified potential areas for improvement, including nonadherence to medical advice, involving patients in their care, and imparting knowledge about their disease condition and treatment.