Patterns of Readmissions for Three Common Conditions Among Younger US Adults

Abstract

Background: Thirty-day readmissions among elderly Medicare patients are an important hospital quality measure. Although plans for using 30-day readmission measures are under consideration for younger patients, little is known about readmission in younger patients or the relationship between readmissions in younger and elderly patients at the same hospital.

Methods: By using the 2014 Nationwide Readmissions Database, we examined readmission patterns in younger patients (18-64 years) using hierarchical models to evaluate associations between hospital 30-day, risk-standardized readmission rates in elderly Medicare patients and readmission risk in younger patients with acute myocardial infarction, heart failure, or pneumonia.

Results: There were 87,818, 98,315, and 103,251 admissions in younger patients for acute myocardial infarction, heart failure, and pneumonia, respectively, with overall 30-day unplanned readmission rates of 8.5%, 21.4%, and 13.7%, respectively. Readmission risk in younger patients was significantly associated with hospital 30-day risk-standardized readmission rates for elderly Medicare patients for all 3 conditions. A decrease in an average hospital's 30-day, risk-standardized readmission rates from the 75th percentile to the 25th percentile was associated with reduction in younger patients' risk of readmission from 8.8% to 8.0% (difference: 0.7%; 95% confidence interval, 0.5-0.9) for acute myocardial infarction; 21.8% to 20.0% (difference: 1.8%; 95% confidence interval, 1.4-2.2) for heart failure; and 13.9% to 13.1% (difference: 0.8%; 95% confidence interval, 0.5-1.0) for pneumonia.

Conclusions: Among younger patients, readmission risk was moderately associated with hospital 30-day, risk-standardized readmission rates in elderly Medicare beneficiaries. Efforts to reduce readmissions among older patients may have important areas of overlap with younger patients, although further research may be necessary to identify specific mechanisms to tailor initiatives to younger patients.

Keywords: Acute myocardial infarction; Heart failure; Patient readmission; Pneumonia.

Figure 1

Percentage of readmissions within 30 days of discharge among younger adult and elderly Medicare patients for 3 conditions. The daily percentage of 30-day readmissions after hospitalizations for acute myocardial infarction (A), heart failure (B), and pneumonia (C) among younger adult and elderly Medicare patients.

Figure 2

Predicted risk of readmission for younger adult patients across a spectrum of hospital 30-day RSRRs among elderly Medicare beneficiaries. Average predicted risks of readmission (solid line) and 95% CIs (shaded area) for younger adult patients admitted for acute myocardial infarction (A), heart failure (B), or pneumonia (C) at varying levels of an average hospital's 30-day RSRR derived from elderly Medicare patients hospitalized for each respective condition.

Supplementary Figure 1

Flow diagram of study sample. *Detailed exclusions are shown in Supplementary Figure 2. AMI = acute myocardial infarction; HF = heart failure; PNA = pneumonia.

Supplementary Figure 2

Flow diagram of admission- and hospital-level exclusions for acute myocardial infarction, heart failure, and pneumonia. A, Acute myocardial infarction. B, Heart failure. C, Pneumonia.

Supplementary Figure 2

Flow diagram of admission- and hospital-level exclusions for acute myocardial infarction, heart failure, and pneumonia. A, Acute myocardial infarction. B, Heart failure. C, Pneumonia.