Emergency department visits and hospital readmissions after a deprescribing intervention among hospitalized older adults

Ji Won Lee; Emily Kay Hollingsworth; Avantika Saraf Shah; Sarah L Szanton; Nancy Perrin; Amanda S Mixon; Eduard Eric Vasilevskis; Cynthia M Boyd; Hae-Ra Han; Ariel R Green; Janiece L Taylor; Sandra Faye Simmons

doi:10.1111/jgs.18945

Emergency department visits and hospital readmissions after a deprescribing intervention among hospitalized older adults

J Am Geriatr Soc. 2024 May 9. doi: 10.1111/jgs.18945. Online ahead of print.

Authors

Ji Won Lee^{1

2}, Emily Kay Hollingsworth³, Avantika Saraf Shah⁴, Sarah L Szanton¹, Nancy Perrin¹, Amanda S Mixon^{3

5}, Eduard Eric Vasilevskis^{3

5

6}, Cynthia M Boyd⁷, Hae-Ra Han¹, Ariel R Green⁷, Janiece L Taylor¹, Sandra Faye Simmons^{3

5}

Affiliations

¹ Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
² Columbia University School of Nursing, New York, USA.
³ Division of Geriatrics, Vanderbilt Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁵ VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA.
⁶ Division of Hospital Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA.
⁷ Johns Hopkins School of Medicine, Center for Transformative Geriatric Research, Baltimore, Maryland, USA.

PMID: 38725307
DOI: 10.1111/jgs.18945

Abstract

Background: Deprescribing is the planned/supervised method of dose reduction or cessation of medications that might be harmful, or no longer be beneficial. Though benefits of deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number of potentially inappropriate medications, which may potentially reduce the risk of adverse events among hospitalized older adults. With unclear evidence for deprescribing in this population, this study aimed to examine time-to-first unplanned healthcare utilization, which included 90-day emergency department (ED) visits or hospital readmission and associated predictors, during a deprescribing intervention.

Methods: A secondary data analysis of a clinical trial (Shed-MEDS NCT02979353) was performed. Cox regression was used to compare the time-to-first 90-day ED visit/readmission/death from hospital discharge for the intervention and control groups. Additionally, we performed exploratory analysis of predictors (comorbidities, functional health status, drug burden index (DBI), hospital length of stay, health literacy, food insecurity, and financial burden) associated with the time-to-first 90-day ED visit/readmission/death.

Results: The hazard of first 90-day ED visits/readmissions/death was 15% lower in the intervention versus the control group (95% CI: 0.61-1.19, p = 0.352, respectively); however, this difference was not statistically significant. For every additional number of comorbidities (Hazard ratio (HR): 1.12, 95% CI: 1.04-1.21) and each additional day of hospital length of stay (HR: 1.04, 95% CI: 1.01-1.07) were significantly associated with a higher hazard of 90-day ED visit/readmission/death in the intervention group; whereas for each unit of increase in pre-hospital DBI score (HR: 1.08 and HR 1.16, respectively) was significantly associated with a higher hazard of 90-day ED visit/readmission/death in the control group.

Conclusions: The intervention and control groups had comparable time-to-first 90-day ED visit/readmission/death during a deprescribing intervention. This finding suggests that deprescribing did not result in a higher risk of ED visit/readmission/death during the 90-day period following hospital discharge.

Keywords: adverse events; deprescribing; emergency department visits; readmissions.

Abstract

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