Prevalence, characteristics and risk factors of frequently readmitted patients to an internal medicine service

Brian C Y Tong; Christine D I Osborne; Chris M Horwood; Paul H Hakendorf; Richard J Woodman; Jordan Y Li

doi:10.1111/imj.15395

Prevalence, characteristics and risk factors of frequently readmitted patients to an internal medicine service

Intern Med J. 2022 Sep;52(9):1561-1568. doi: 10.1111/imj.15395. Epub 2022 May 31.

Authors

Brian C Y Tong¹, Christine D I Osborne¹, Chris M Horwood², Paul H Hakendorf², Richard J Woodman^{1

3}, Jordan Y Li^{1

4}

Affiliations

¹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
² Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia, Australia.
³ Centre for Epidemiology and Biostatistics, College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia.
⁴ Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.

PMID: 34031965
DOI: 10.1111/imj.15395

Abstract

Background: Unplanned hospital readmissions (HRA), which have been used as key performance index of healthcare quality, are becoming more prevalent. They are associated with substantial financial burden to hospital systems and considerable impacts on patients' physical and mental health. Patients with frequent readmissions are not well studied.

Aims: To determine the prevalence, characteristics and risk factors associated with frequent readmissions (FRA) to an internal medicine service at a tertiary public hospital.

Method: A retrospective observational study was conducted at an internal medicine service in a tertiary teaching hospital between 1 January 2010 and 30 June 2016. FRA was defined as four or more readmissions within 12 months of discharge from the index admission (IA). Demographic and clinical characteristics and potential risk factors were evaluated.

Results: A total of 50 515 patients was included; 1657 (3.3%) had FRA and were associated with nearly 2.5 times higher in 12-month mortality rates. They were older, had higher rates of indigenous Australians (3.2%), more disadvantaged status (index of relative socio-economic disadvantage decile of 5.3) and more comorbidities (mean Charlson comorbidity index 1.4) in comparison, to infrequent readmission group. The mean length of hospital stay during the IA was 6 days for FRA group (21.4% staying more than 7 days) with higher incidence of discharge against medical advice (2.0% higher). Intensive care unit admission rate was 6.6% for FRA group compared with 3.9% for infrequent readmission group. Multivariate analysis showed mental disease and disorders, neoplastic, alcohol/drug use and alcohol/drug-induced organic mental disorders are associated with FRA.

Conclusion: The risk factors associated with FRA were older age, indigenous status, being socially disadvantaged, having higher comorbidities and discharging against medical advice. Conditions that lead to FRA were mental disorders, alcohol/drug use and alcohol/drug-induced organic mental disorders and neoplastic disorders.

Keywords: comorbidity; frequent readmission; hospital readmission; mortality; re-presentation; rehospitalisation.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Humans
Internal Medicine*
Length of Stay
Patient Readmission*
Prevalence
Retrospective Studies
Risk Factors
Tertiary Care Centers
Time Factors