Risk factors for potentially avoidable readmissions due to end-of-life care issues

J Hosp Med. 2014 May;9(5):310-4. doi: 10.1002/jhm.2173. Epub 2014 Feb 14.


Background: Repeated hospitalizations are frequent toward the end of life, where each admission should be an opportunity to initiate advance-care planning to high-risk patients.

Objective: To identify the risk factors for having a 30-day potentially avoidable readmission due to end-of-life care issues among all medical patients.

Design: Nested case-control study.

Setting/patients: All 10,275 consecutive discharges from any medical service of an academic tertiary medical center in Boston, Massachusetts between July 1, 2009 and June 30, 2010.

Measurements: A random sample of all the potentially avoidable 30-day readmissions was independently reviewed by 9 trained physicians to identify the ones due to end-of-life issues.

Results: Among 534, 30-day potentially avoidable readmission cases reviewed, 80 (15%) were due to an end-of-life care issue. In multivariable analysis, the following risk factors were significantly associated with a 30-day potentially avoidable readmission due to end-of-life care issues: number of admissions in the previous 12 months (odds ratio [OR]: 1.10 per admission, 95% confidence interval [CI]: 1.02-1.20), neoplasm (OR: 5.60, 95% CI: 2.85-10.98), opiate medications at discharge (OR: 2.29, 95% CI: 1.29-4.07), Elixhauser comorbidity index (OR: 1.16 per 5-point increase, 95% CI: 1.10-1.22). The discrimination of the model (C statistic) was 0.85.

Conclusions: In a medical population, we identified 4 main risk factors that were significantly associated with 30-day potentially avoidable readmission due to end-of-life care issues, producing a model with very good to excellent discrimination. Patients with these risk factors might benefit from palliative care consultation prior to discharge in order to improve end-of-life care and possibly reduce unnecessary rehospitalizations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Boston
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasms / complications*
  • Patient Discharge / standards
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission / statistics & numerical data*
  • Risk Factors
  • Terminal Care*
  • Time Factors


  • Analgesics, Opioid