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. 2013 Dec 16:347:f7171.
doi: 10.1136/bmj.f7171.

Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study

Jacques Donzé  1 , Stuart Lipsitz, David W Bates, Jeffrey L Schnipper
Affiliations

Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study

Jacques Donzé et al. BMJ. .

Abstract

Objective: To evaluate the primary diagnoses and patterns of 30 day readmissions and potentially avoidable readmissions in medical patients with each of the most common comorbidities.

Design: Retrospective cohort study.

Setting: Academic tertiary medical centre in Boston, 2009-10.

Participants: 10,731 consecutive adult discharges from a medical department.

Main outcome measures: Primary readmission diagnoses of readmissions within 30 days of discharge and potentially avoidable 30 day readmissions to the index hospital or two other hospitals in its network.

Results: Among 10,731 discharges, 2398 (22.3%) were followed by a 30 day readmission, of which 858 (8.0%) were identified as potentially avoidable. Overall, infection, neoplasm, heart failure, gastrointestinal disorder, and liver disorder were the most frequent primary diagnoses of potentially avoidable readmissions. Almost all of the top five diagnoses of potentially avoidable readmissions for each comorbidity were possible direct or indirect complications of that comorbidity. In patients with a comorbidity of heart failure, diabetes, ischemic heart disease, atrial fibrillation, or chronic kidney disease, the most common diagnosis of potentially avoidable readmission was acute heart failure. Patients with neoplasm, heart failure, and chronic kidney disease had a higher risk of potentially avoidable readmissions than did those without those comorbidities.

Conclusions: The five most common primary diagnoses of potentially avoidable readmissions were usually possible complications of an underlying comorbidity. Post-discharge care should focus attention not just on the primary index admission diagnosis but also on the comorbidities patients have.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: JD was supported by the Swiss National Science Foundation and the Swiss Foundation for Medical-Biological Scholarships; JLS is a consultant to QuantiaMD, for whom he has helped to create online educational materials for both providers and patients regarding patient safety, including drug safety, during transitions in care (the findings of this study are not a part of those materials); JLS has received grant funding from Sanofi Aventis for an investigator initiated study to design and evaluate an intensive discharge and follow-up intervention in patients with diabetes; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of study
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Fig 2 Match between primary diagnosis of index admission and 30 day potentially avoidable readmission among patients readmitted for acute exacerbation of their comorbidity. Diabetes mellitus is not shown because MS-DRG codes do not capture hyperglycemia specifically
See this image and copyright information in PMC

References

    1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418-28. - PubMed
    1. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA 2013;309:355-63. - PMC - PubMed
    1. Zekry D, Loures Valle BH, Graf C, Michel JP, Gold G, Krause KH, et al. Prospective comparison of 6 comorbidity indices as predictors of 1-year post-hospital discharge institutionalization, readmission, and mortality in elderly individuals. J Am Med Dir Assoc 2012;13:272-8. - PubMed
    1. Van WC, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 2010;182:551-7. - PMC - PubMed
    1. Librero J, Peiro S, Ordinana R. Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. J Clin Epidemiol 1999;52:171-9. - PubMed

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